Effects of perceived patient demand on prescribing anti-infective drugs

Background: Although patient demand is frequently cited by physicians as a reason for inappropriate prescribing, the phenomenon has not been adequatel y studied. The objectives of this study were to determine the prevalence of perceived patient demand in physician-patient encounters; to identify char acteristics of the patient, physician and prescribing situation that are as sociated with perceived demand; and to determine the influence of perceived demand on physicians' prescribing behaviour. Methods: An observational study using 2 survey approaches was conducted in February and March 1996. Over a 2-day period 20 family physicians in the To ronto area completed a brief questionnaire for each patient encounter relat ed to suspected infectious disease. Physicians were later asked in an inter view to select and describe 1 or 2 incidents from these encounters during w hich perceived patient demand influenced their prescribing (critical incide nt technique). Results: Perceived patient demand was reported in 124 (48%) of the 260 phys ician-patient encounters; however, in almost 80% of these encounters physic ians did not think that the demand had much influence on their decision to prescribe an anti-infective. When clinical need was uncertain, 28 (82%) of 34 patients seeking an anti-infective were prescribed one, and physicians r eported that they were influenced either "moderately" or "quite a bit" by p erceived patient demand in over 50% of these cases. Of the 35 critical pres cribing incidents identified during the interviews, anti-infectives were pr escribed in 17 (49%); the reasons for prescribing in these situations were categorized. Interpretation: This study provides preliminary data on the prevalence and influence of perceived patient demand in prescribing anti-infectives. Patie nt demand had more influence on prescribing when physicians were uncertain of the need for an anti-infective.