Survey of whether general practitioners carry aspirin in their doctor's bagBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6931.761 (Published 19 March 1994) Cite this as: BMJ 1994;308:761
- M Moher,
- D Mohera,
- P Havelock
- aSouthmead Surgery, Farnham Common, Buckinghamshire SL2 3ER
- Clinical Epidemiology Unit, Loeb Medical Research Institute, Ottawa, Ontario, Canada K1Y 4E9
- Pound House Surgery, Wooburn Green, Buckinghamshire HP10 0EE
- Correspondence to: Dr
Our previous study found that less than a fifth of patients admitted to hospital with suspected acute myocardial infarction had been given aspirin by their general practitioner before their admission.1 This result is surprising given that the early use of aspirin, alone or in combination with intravenous thrombolytic agents, is obviously beneficial2 and that guidelines have been published on such use.3 We suspected that one of the reasons for the low use of aspirin was that general practitioners were not carrying the drug in their doctor's bag. We therefore conducted a survey to investigate this hypothesis further.
Subjects, methods, and results
We selected the study sample in June 1993 with the help of Oxford Regional Health Authority, which has a computerised list of all general practitioners in the region. Once the first general practitioner's name was randomly chosen we systematically selected every second name from the list. Data were collected by means of a standardised, self administered postal questionnaire, which was sent to each participating general practitioner. No reminders were sent. Demographic data (age and sex) and whether the general practitioner belonged to a training practice were recorded. In addition, the questionnaire asked whether the general practitioner carried each of six common drugs, including aspirin, in their doctor's bag.
Returned questionnaires were analysed by the Epi-Info package.4 The drugs carried by general practitioners from training and non-training practices were compared. The differences were evaluated using relative risks and 95% confidence intervals. Analysis of the non-responders showed them to be no different from the responders with regard to age, sex, and type of practice.
Of the 670 questionnaires sent, 593 were returned (88.5%); 15 were either blank or incomplete, which left 578 (86.2%) completed questionnaires available for analysis. Of these, 412 were from male general practitioners. Less than half (252) of the respondents were aged 25-39, the remainder being 40-54 (258) or 55-69 (68). More than a third of the respondents (213) were from a training practice. Penicillin was carried by the most general practitioners (556) and aspirin by the fewest (346). General practitioners in a training practice were significantly more likely to carry aspirin than their counterparts in a non-training practice (relative risk 1.63; table).
General practitioners are ideally placed to initiate early treatment with aspirin in patients with suspected acute myocardial infarction. This is in line with the British Heart Foundation's guidelines based on the results of several major randomised clinical trials.3 It is therefore worrying that 40% of the general practitioners in our study did not carry aspirin in their doctor's bag.
Few investigations have examined whether the results of clinical trials influence clinical practice. Our study suggests that any influence on general practice is limited. Further investigation is needed into why the results of clinical trials are not applied and how education can change behaviour. Researchers may have a responsibility to consider the implementation of results when planning their trials, and this could include liaison with postgraduate educators. In this context, further investigation is also needed into why general practitioners in training practices seem to be more aware of the need to carry aspirin, as is suggested by our study. The educational input into training practices may be high: how this may change behaviour needs more understanding.
We thank Amanda Johnstone, Liz Kwantes, Colin Baigent, and Sally Middleton for their help.