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Physician Attitudes and Beliefs Affect Prescribing Patterns of Injectable Therapy: Presented at BHIVA

By Ted Bosworth

BRIGHTON, UK -- April 5, 2006 -- Physician preconceptions and beliefs about injectable drugs appear to explain the unexpectedly low rate of prescriptions for the entry inhibitor enfuvirtide in highly treatment-experienced patients with HIV, researchers said here at the 12^th Annual Conference of the British HIV Association (BHIVA).

Although there are well-controlled studies documenting the benefits of enfuvirtide in patients with resistance to multiple antiretroviral classes, several surveys have suggested that only a proportion of appropriate candidates receive this therapy. A study that employed physician interviews suggested that attitudes rather than data play at least some role in this phenomenon.

"The interviews demonstrated significant variability in physician beliefs about injectables, and these beliefs had a strong influence on the willingness of the doctor to consider enfuvirtide in specific situations," reported Robert Horne, MRPharmS, PhD, professor of psychology, University of Brighton, Brighton, United Kingdom.

In a presentation of these data, Dr. Horne indicated that 1 of the most important obstacles to the use of enfuvirtide is that a high proportion of physicians anticipate poor acceptance by patients.

In this study, interviews about the use of enfuvirtide and perceptions about injectable drugs were completed by 499 physicians in the United States and the European Union who treat patients with HIV. Based on history of prescribing, the physicians were divided into 3 groups. Group 1, representing 24% of the study population, had never prescribed enfuvirtide. Group 2, representing 41%, had prescribed enfuvirtide in fewer than 5 patients. Group 3, representing 35%, had prescribed enfuvirtide in 5 or more patients.

The study authors noted that UK physicians were significantly more likely (P <.001) than other physicians to have never prescribed enfuvirtide.

When the 3 groups were compared, physicians who had never prescribed enfuvirtide were significantly more likely (P <.05) than the other 2 groups to express the opinion that enfuvirtide is harder to justify than other antiretroviral therapies in regard to time and resources required, that it is more likely to be refused by patients or to be associated with poor patient adherence, and that prescribing enfuvirtide carries a substantial potential for jeopardizing the patient's trust.

The researchers also compared physician responses to the potential role of enfuvirtide in 2 hypothetical cases that were considered to be representative of clinical situations in which enfuvirtide might be appropriate, even though 1 patient was described as having a previous history of intravenous drug abuse, and the other was described as having a previous history of nonadherence.

Not surprisingly, physicians who reported that they would consider enfuvirtide in either case had expressed more confidence in the efficacy of enfuvirtide in the interview. In the specific case of a patient with a history of nonadherence, those willing to consider enfuvirtide were less likely to have expressed concern about adherence with an injectable drug.

The reluctance of physicians to prescribe enfuvirtide is not well grounded by objective data, Dr. Horne said. He implied that some patients who might benefit from enfuvirtide are not being offered this therapy as an option.

These data suggest that physician beliefs may be getting in the way of delivery of effective antiretroviral therapy, he concluded.


[Presentation title: Understanding Variation in Prescribing of Injectable Therapy: The Role of Physician Attitudes and Beliefs. Abstract P90]

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