Neurology, Vol 50, Issue 6 1661-1668, Copyright © 1998 by American Academy of Neurology

ARTICLES

Practice styles of US compared to UK neurologists

BG Vickrey, DR Gifford, TR Belin, PJ Martin, D Smith, S Delrahim and DW Chadwick
Department of Neurology, University of California, Los Angeles 90095- 1769, USA.

OBJECTIVE: This study assessed variation between neurologists in the United States and United Kingdom in their diagnostic and treatment decisions for commonly encountered neurologic presentations, and identified explanatory factors for any observed variation. METHODS: All 210 consultant neurologists in the United Kingdom and a nationally representative sample of 595 US neurologists received mailed surveys containing three detailed clinical scenarios depicting patients with (1) a single unprovoked seizure occurring 3 days previously, (2) early Parkinson's disease, and (3) dementia. The main study outcome measures were self-reported decisions regarding diagnostic test ordering and treatment, which were assessed after each scenario. Neurologists' practice characteristics, certainty about the diagnosis, and attitudes toward uncertainty were also measured. Survey response rates were 92% of US and 63% of UK neurologists. RESULTS: A higher proportion of US than UK neurologists indicated they would order additional diagnostic tests for all three scenarios (all p < 0.05); 77% of UK compared with 26% of US neurologists would manage a single unprovoked seizure without antiepileptic medication (p < 0.0001), but treatment of early Parkinson's disease was not different. Nearly all US and UK neurologists would obtain a neuroimaging study in the evaluation of dementia. International differences persisted after adjustment for differences in demographic and practice characteristics and for attitudes toward test use and clinical uncertainty. CONCLUSIONS: We identified large international variation in clinical decisions across three common neurologic conditions. Cross-country collaboration should explore these differences to develop consensus on standards of care.

This article has been cited by other articles:

				B. G. Vickrey When the patient knows best: A challenge in translating clinical trial evidence into practice Neurology, April 10, 2007; 68(15): 1172 - 1173. [Full Text] [PDF]

				G. L. Birbeck, D. R. Gifford, J. Song, T. R. Belin, B S. Mittman, and B. G. Vickrey Do malpractice concerns, payment mechanisms, and attitudes influence test-ordering decisions? Neurology, January 13, 2004; 62(1): 119 - 121. [Abstract] [Full Text] [PDF]

				A Ghosh, S P Kelly, J Mathews, P N Cooper, and N Macdermott Evaluation of the management of optic neuritis: audit on the neurological and ophthalmological practice in the north west of England J. Neurol. Neurosurg. Psychiatry, January 1, 2002; 72(1): 119 - 121. [Abstract] [Full Text] [PDF]

				D. R. Gifford, R. G. Holloway, M. R. Frankel, C. L. Albright, R. Meyerson, R. C. Griggs, and B. G. Vickrey Improving Adherence to Dementia Guidelines through Education and Opinion Leaders: A Randomized, Controlled Trial Ann Intern Med, August 17, 1999; 131(4): 237 - 246. [Abstract] [Full Text] [PDF]