PHYSICIAN MOTIVATIONS FOR NONSCIENTIFIC DRUG PRESCRIBING
PHYSICIAN MOTIVATIONS FOR NONSCIENTIFIC DRUG PRESCRIBING
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DOI：
10.1016/0277-9536(89)90252-9
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发表时间：
1989-01-01
影响因子：
5.4
通讯作者：
AVORN, J
中科院分区：
文献类型：
--
作者：
SCHWARTZ, RK;SOUMERAI, SB;AVORN, J
虽然越来越多的人关注不适当的医生处方，以及如何制定计划，以改善药物治疗的决定，很少有研究已经发表记录的原因，这种错误的处方。我们分析了141名医生报告的动机，他们是一项大型的“学术细节”多州随机对照试验的一部分。从州医疗补助处方记录中确定医生为脑或外周血管扩张剂、丙氧芬或头孢氨苄的中度至高度处方者，并由临床药剂师访问，作为基于医学院的处方改进计划中的推广教育。医生的处方模式的动机进行了讨论，在一个非正式的，互动的方式，所有的反应都详细记录了药剂师在每次访问后立即。在110份回复中，医生提供的使用这些药物的最常见原因是患者需求（51份声明，或46%）。医生还经常将这些药物的处方归因于故意使用安慰剂效应（24%）。一个同样常见的原因是，处方者声称他们自己的临床经验表明，这些药物实际上是治疗所提出的条件（26%），尽管研究文献的证据表明情况并非如此。这些适应症包括使用“血管扩张剂"治疗老年性痴呆或外周血管疾病，头孢氨苄治疗病毒性上呼吸道感染，丙氧芬代替对乙酰氨基酚或阿司匹林治疗轻度疼痛。如果计划要成功地用更合理的临床决策取代这些做法，就必须更加关注医生对次优处方的态度和动机。
Although there is increasing concern about inappropriate physicians prescribing and how to devise programs to improve drug therapy decisions, little research has been published documenting the reasons for such misprescribing. We analyzed the motivations reported by 141 physicians who were part of a large multi-state randomized controlled trial of ''academic detailing''. The physicians were identified from state Medicaid prescribing records as moderate to high prescribers of cerebral or peripheral vasodilators, propoxyphene, or cephalexin, and were visited by clinical pharmacists serving as outreach educations in a medical school-based prescribing improvement program. Physicians'' motivations for their prescribing patterns were discussed in an informal, interactive manner; all responses were recorded in detail by the pharmacists immediately following each visit. Of the 110 responses elicited, the most common reason offered by physicians for use of these medications was patient demand (51 statements, or 46%). Physicians also frequently attributed their prescribing of these drugs to intentional use of placebo effect (24%). An equally common reason was prescribers'' assertion that their own clinical experience indicated that these drugs were actually therapies of choice in the conditions presented (26%), despite evidence from the research literature that this was not the case. Such indications included the use of the ''vasodilators'' for senile dementia or peripheral vascular disease, cephalexin for viral upper respiratory infections, and propoxyphene instead of acetaminophen or aspirin for mild pain. Greater attention must be paid to physician''s attitudes and motivations concerning suboptimal prescribing if programs are to succeed in replacing these practices with more rational clinical decision-making.