A study of general practitioners' reasons for changing their prescribing behaviour

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Abstract
Objectives: To explore general practitioners' reasons for recent changes in their prescribing behaviour. Design: Qualitative analysis of semistructured interviews. Setting: General practice in south east London. Subjects: A heterogeneous sample of 18 general practitioners. Results: Interviewees were able to identify between two and five specific changes that had occurred in their prescribing in the preceding six months. The most frequently mentioned changes related to fluoxetine, angiotensin converting enzyme inhibitors, and the antibiotic treatment of Helicobacter pylori. Three models of change were identified: an accumulation model, in which the volume and authority of evidence were important; a challenge model, in which behaviour change followed a dramatic or conflictual clinical event; and a continuity model, in which change took place against a background of willingness to change, modulated by other factors such as cost pressures and the comprehensible therapeutic action of a drug. Behaviour change was reinforced and sustained by experiences with individual patients. Conclusions: Multiple factors are involved in general practitioners' decisions to change their prescribing habits. Three models of change can be identified which have important implications for the design and evaluation of interventions aimed at behaviour change. Key messages General practitioners respond to different types of cue to change their prescribing Many change agents seem to have their power through surprise or conflict and it may be possible to simulate therapeutic challenges together with appropriate educational support The traditional agencies of change—clinical meetings, journal editorials, and so on—cannot be expected to bring about change on a large scale; at best they can help prepare the ground Change is initially precarious and needs reinforcement if it is to be maintained