Why are some doctors high-prescribers of benzodiazepines and minor opiates? A qualitative study of GPs in Norway
Why are some doctors high-prescribers of benzodiazepines and minor opiates? A qualitative study of GPs in Norway
复制标题
DOI：
10.1093/fampra/14.5.361
复制
发表时间：
1997-10-01
期刊：
影响因子：
2.2
通讯作者：
Laerum, E
中科院分区：
文献类型：
--
作者：
Dybwad, TB;Kjolsrod, L;Laerum, E
背景资料。注册研究表明，不同全科医生在苯二氮类药物(BZD)和少量阿片类药物的处方数量和处方模式上存在很大差异。我们的目的是形成假设的基础，并建立关于处方的理论，以调查高处方医生如何使自己的处方模式合法化。对已知的高、中、低处方数量的医生进行了定性访谈研究。解释的重点是医生的自我解释以及他们如何影响他们的日常处方决定。结果和结论。一个显著的特点是，在三组处方医生内部和之间，对药物的许多态度都是共同的。所有医生都认为开药任务艰巨，绝大多数医生强烈主张限制开药。为了应对日常实践和适应高开药量，医生采用了有效的工作策略。这些策略，归因于以前的医生，患者的自主性和责任感，患者的年龄和伴随的疾病，在这项研究中被描述。将责任分配给其他人或情况界定了医生在这一问题上的专业自由裁量权。在分析中没有发现处方组之间的显著差异，但当添加决策过程所有步骤中的所有小趋势时，显示出明显的趋势。
Background. Registration studies have shown great variations in prescribing volume and prescribing patterns of benzodiazepines (BZDs) and minor opiates among GPs.Objectives. We aimed to form a basis for hypotheses and build theories about prescribing, in order to investigate how high-prescribing doctors can legitimize their own prescribing pattern.Methods. A qualitative interview study of doctors with previously known high, medium and low prescribing volumes was performed. The interpretation focused on the doctors' self-explanations and how they influence their daily decision of prescribing.Results and conclusions. It was a striking feature that many of the attitudes towards the drugs were common both within and between the three groups of prescribers. All doctors regarded the task of prescribing as difficult, and the great majority strongly advocated restriction in prescribing. In order to cope with daily practice and to live with high prescribing volumes, doctors make use of effective working strategies. These strategies, of ascribing responsibility to the previous doctor, to patient autonomy and responsibility, to the patient's age and to concomitant diseases, are described in this study. An allocation of responsibility to other persons or circumstances delimits the doctors' professional discretion in this matter. Striking differences between prescriber groups were not found in the analysis, but when all small tendencies in all steps of the decision-making process were added, a clear trend was revealed.