DRUG EXPECTATIONS AND DRUG CHOICES OF HOSPITAL PHYSICIANS

Objectives. To assess whether differences in drug choices of hospital physicians are related to differences in the underlying decision-makin g process. Design. A survey study was conducted addressing drug choice s in six therapeutic fields with existing interprescriber variations; prescribers and non-prescribers of drugs of which the merits were not sufficiently proven (i.e. the 'target drugs') were compared. Setting. A 1000-bed university hospital in The Netherlands. Subjects. AU 85 hos pital physicians working in specialities involving one of the selected fields were asked to participate; 72 physicians completed the intervi ews. Main outcome measures. Comparisons were made regarding three elem ents of the decision-making process: (1) the physicians' expectations of the target drugs and frequently used alternatives, (2) the weights attached to the principal treatment aspects, and (3) the extent to whi ch their actual choice is based on these expectations and weights. Res ults. In three fields, i.e. anti-emetics, vasodilators, and platelet i nhibitors, the prescribers of the less desirable target drugs had high er expectations of these drugs in comparison to the non-prescribers. I n the other therapeutic fields, choosing target drugs was related eith er to attaching less importance to side-effects and costs, or to attac hing less importance to reports from clinical trials. Twenty of the 46 treatment choices of the prescribers of target drugs could not be pre dicted from their expressed views as opposed to 5 of the 36 choices of the non-prescribers (P < 0.05). Conclusions. Choosing less desirable drugs is not always related to having too high expectations of the dru g. Assigning a different importance to certain aspects of the drug and resorting to decision strategies that do not include the weighing of all pros and cons provide alternative explanations for such treatment choices.