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A qualitative study to explore influences on general practitioners' decisions to prescribe new drugs
Ann Jacoby1, Monica Smith, Martin Eccles
1Department of Primary Care, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB. ajacoby@liv.ac.uk
Background:
Ensuring appropriate prescribing is an important challenge for the health service, and the need for research that takes account of the reasons behind individual general practitioners' (GPs) prescribing decisions has been highlighted.
Aim:
To explore differences among GPs in their decisions to prescribe new drugs.
Design Of Study:
Qualitative approach, using in-depth semistructured interviews.
Setting:
Northern and Yorkshire Health Authority Region.
Method:
Participants were identified from a random sample of 520 GPs in a quantitative study of patterns of uptake of eight recently introduced drugs. Purposeful sampling ensured inclusion of GPs prescribing any of the eight drugs and working in a range of practice settings. Fifty-six GPs were interviewed, using a topic guide. Interviews were recorded on audiotape. Transcribed text was methodically coded and data were analysed by constantly comparing emerging themes.
Results:
Both low and high prescribers shared a view of themselves as conservative in their prescribing behaviour. Low prescribers appeared to conform more strongly to group norms and identified a consensus among practice partners in prescribing and cost-consciousness. Conformism to group norms was represented by a commitment to practice formularies. High prescribers more often expressed themselves to be indifferent to drug costs and a shared practice ethos.
Conclusions:
A shift in the attitudes of some GPs is required before cost-effectiveness is routinely incorporated in drug prescribing. The promotion of rational prescribing is likely to be more successful if efforts are focused on GPs' appreciation of cost issues and attitudes towards shared decision-making and responsibility.