IMPROVING THE APPROPRIATENESS OF PHYSICIAN PRESCRIBING

Appropriate prescribing means that prescribers should try to maximize effectiveness, minimize risks and costs, and respect patients' choices . Evidence from studies on prescribing to individuals and from adminis trative databases reveals a significant level of inappropriate prescri bing by Canadian physicians. Two important reasons for inappropriate p rescribing seem to be physicians' level of knowledge and physicians' p ractice settings. A large number of methods have been tried to improve prescribing behavior, but most are unsuccessful. Academic detailing, and audit and feedback, have both been shown to work but may be diffic ult to implement in Canada, where most physicians practice in solo fee -for-service settings. Alternative forms of physician payment such as capitation or salary are probably necessary to make prescribing more a ppropriate.