A study of factors associated with cost and variation in prescribing among GPs
A study of factors associated with cost and variation in prescribing among GPs
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DOI：
10.1093/fampra/17.1.36
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发表时间：
2000-02-01
期刊：
影响因子：
2.2
通讯作者：
Watkins, C
中科院分区：
文献类型：
--
作者：
Carthy, P;Harvey, I;Watkins, C
背景不适当的处方有可能伤害个人和社会。以前的研究已经确定了医生或人口特征，影响处方的变化，但不适合改变。确定与GP处方方差和成本相关的可修改因素。质性研究方法采用半结构录音访谈17全科医生在埃文，西南NHS地区，英国。全科医生认为自己是谨慎和保守的处方者。尽管临床或成本争论相互矛盾，但处方者的处方决定往往是合理的。个人开发的药物处方被用来减少可能与处方不确定性相关的困境。愿意反思，并衡量，处方习惯对设定的专业标准差异很大。处方决定缺乏监测机制，加上社区药剂师利用不足，导致处方结果不确定。一些全科医生发现很难跟上最新的专业由于感知的时间限制。过度的病人需求被认为是影响他们的处方，但全科医生说，他们没有不适当的影响药物代表。开处方对健康和预算有相当大的影响，但仍然是一个有争议的问题。必须在病人、医生和药剂师之间建立更好的伙伴关系。需要通过政策制定和教育干预来更好地监测和支持处方决策，以减少处方的不确定性。新成立的初级保健小组可能需要反思处方医生面临的困难，特别是在现金有限的预算内开处方时，以避免处方行为与当地政策制定之间的不协调。
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.