A study of factors associated with cost and variation in prescribing among GPs

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Abstract
Background. Inappropriate prescribing has the potential to harm both the individual and society. Previous research has identified doctor or demographic characteristics that influence prescribing variation but which were not amenable to change. Objectives. To identify modifiable factors associated with GP prescribing variance and cost. Method. Qualitative research methods were used in semi-structured taped interviews with 17 GPs in Avon, South West NHS Region, UK. Results. GPs considered themselves cautious and conservative prescribers. Prescribing decisions often were justified by the prescriber, despite conflicting clinical or cost arguments. A personally developed drug formulary was used to reduce dilemmas potentially associated with prescribing uncertainty. Willingness to reflect upon, and measure, prescribing habits against set professional standards varied considerably. The absence of monitoring mechanisms of prescribing decisions, coupled with under utilization of the community pharmacist, resulted in uncertain prescribing outcomes. Some GPs found it difficult to keep up to date professionally due to perceived time constraints. Excessive patient demand was considered to influence their prescribing, but GPs stated that they were not unduly influenced by the drug representative. Conclusions. Prescribing makes a considerable impact on health and budgets and yet remains a contentious issue. Improved partnerships between patient, doctor and pharmacist must be established. Better prescribing decision monitoring and support through policy development and educational intervention is needed to reduce prescribing uncertainty. Newly established Primary Care Groups may need to reflect upon the difficulties facing prescribers, particularly when prescribing within cash-limited budgets, to avoid discord between prescribing behaviour and local policy development.