Influences on
general practitioners'
decision to prescribe new drugs-the importance of who says
what.
Prosser H, Almond S, Walley
T.
Prescribing Research Group, Department of Pharmacology and
Therapeutics, The Infirmary, 70 Pembroke Place, Liverpool L69 3GF and
Royal Liverpool University Hospital, Liverpool L7 8XP,
UK.
OBJECTIVES: The aim of this study was to understand the range
of factors that influence general practitioners' uptake of new drugs METHODS: A total of
107 general practitioners selected purposively from high, medium and low new drug
prescribing practices in two health authorities in the north west of
England were interviewed using the critical incident technique with
semi-structured interviews. Interview topics included reasons for
prescribing new drugs launched between January 1998 and May 1999;
reasons for prescribing the new drug rather than alternatives; and
sources of information used for each prescribed drug. RESULTS: Important
biomedical influences were the failure of current therapy and adverse
effect profile. More influential than these, however, was the
pharmaceutical representative. Hospital consultants and observation of
hospital prescribing was cited next most frequently. Patient request for
a drug, and patient convenience and acceptability were also likely to
influence new drug uptake. Written information was of limited importance
except for local guidelines. general practitioners were largely reactive and opportunistic
recipients of new drug information, rarely reporting an active
information search. The decision to initiate a new drug is heavily
influenced by 'who says what', in particular the pharmaceutical
industry, hospital consultants and patients. The decision to 'adopt' a
new drug is clinched by subsequent personal clinical experience.
CONCLUSIONS: Prescribing of new drugs is not simply related to
biomedical evaluation and critical appraisal but, more importantly, to
the mode of exposure to pharmacological information and social
influences on decision making. Viewed within this broad context,
prescribing variation becomes more understandable. Findings have
implications for the implementation of evidence-based medicine, which
requires a multifaceted approach.
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