Introduction. Research into medications for Alzheimer's disease (AD) is primarily conducted in drug trials, were efficacy is assessed by changes in score on established outcome measurement scales. However, physicians' and caregivers' perspectives on efficacy, along with their perspectives on other factors that may influence prescribing (e.g., adverse effects), remain largely unexplored. The objective of this thesis is to examine these perspectives to gain a broader understanding of the factors that can influence the use of medications in AD. / Methods. Two studies were conducted. The first involved all of the Province of Quebec's geriatricians, neurologists, and psychogeriatricians, as well as a random sample of Quebec's 8,115 general practitioners. The second study involved 375 caregivers who attended AD-related support groups. Questionnaires were used to collect data on the proportion of patients prescribed cholinesterase inhibitors (ChEIs), efficacy requirements for prescribing new medications, acceptance of adverse effects, physician-caregivers discussions about medications, and caregiver pressure on physicians to prescribe medications. / Results. Response rates were 35.4% (physicians) and 64.4% (caregivers). More stringent efficacy requirements on the part of physicians were negatively associated with prescribing ChEIs, although effect sizes were small and associations were not always statistically significant. More stringent efficacy requirements on the part of caregivers were negatively associated with prescribing in some instances (e.g., required improvements to patients' ability to eat, OR=0.74, 95% CI=0.61 to 0.89), but not in others (e.g., required improvements to patients' speech, OR=1.02, 95% CI=0.81 to 1.19). Caregivers' willingness to accept adverse effects was positively associated with prescribing ChEIs (odds ratios for 11 adverse effects ranged from 1.83 to 8.30); however, prescribing was not associated with physicians being the first to discuss the use of medications to treat AD (OR=2.37; 95% CI=0.90 to 6.24), nor was it associated with caregiver pressure on physicians to prescribe (OR=1.33; 95% CI=0.49 to 3.58). / Conclusion. This research is the first to show how physician and caregiver perspectives on issues such as efficacy and safety can affect the use of medications in AD.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.85947 |
| Date | January 2005 |
| Creators | Oremus, Mark, 1968- |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Doctor of Philosophy (Department of Epidemiology and Biostatistics.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 002260930, proquestno: AAINR21684, Theses scanned by UMI/ProQuest. |
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