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Table 1 Clinical practice scenarios employed to situate focus group sessions

From: Family Physician attitudes about prescribing using a drug formulary

Condition

Presentation

Asthma

A 35 year old asthmatic woman has recently moved into subsidized housing where there are cats. One year ago she had a normal spirometry but has recently experienced coughing, and dyspnea with wheezing and disturbed sleep. She inhales budesonide daily and has increased her use of terbutaline with the recent increase in symptoms. She is reluctant to increase her us e of corticosteroids.

Hypertension

A 55 year old male has type 2 diabetes that is currently managed with diet and exercise. Physical exam, ECG, BMI, and renal function are normal. Lipid levels are not at recommended targets per the CCS guidelines and repeated BP readings indicate mild to moderate hypertension.

Osteoarthritis

A 41 year old female began to have right hip pain four years ago that progressed to both hips and knees. Three months of acetaminophen was ineffective for pain relief; naproxen caused dyspepsia and a positive occult blood stool sample. Her smoking cessation efforts (pack-a-day) resulted in weight gain that exacerbated her joint pain. Pain is now daily and may force a job change if not controlled.

Osteoporosis

A 75 year old male has become progressively more stooped and experienced episodes of back pain over the past 6 months. Densiometry revealed a BMI > 2 SD below the mean for young men and a serum testosterone level on the low end of normal. He has now suffered a fractured wrist in an accidental fall.