A study of factors associated with cost and variation in prescribing amongGPs

Background. Inappropriate prescribing has the potential to harm both the in dividual and society. Previous research has identified doctor or demographi c characteristics that influence prescribing variation but which were not a menable to change. Objectives. To identify modifiable factors associated with GP prescribing v ariance and cost. Method. Qualitative research methods were used in semi-structured taped int erviews with 17 GPs in Avon, South West NHS Region, UK. Results. GPs considered themselves cautious and conservative prescribers. P rescribing decisions often were justified by the prescriber, despite confli cting clinical or cost arguments. A personally developed drug formulary was used to reduce dilemmas potentially associated with prescribing uncertaint y. Willingness to reflect upon, and measure, prescribing habits against set professional standards varied considerably. The absence of monitoring mech anisms of prescribing decisions, coupled with under utilization of the comm unity pharmacist, resulted in uncertain prescribing outcomes. Some GPs foun d it difficult to keep up to date professionally due to perceived time cons traints. Excessive patient demand was considered to influence their prescri bing, but GPs stated that they were not unduly influenced by the drug repre sentative. Conclusions. Prescribing makes a considerable impact on health and budgets and yet remains a contentious issue. Improved partnerships between patient, doctor and pharmacist must be established. Better prescribing decision mon itoring and support through policy development and educational intervention is needed to reduce prescribing uncertainty. Newly established Primary Car e Groups may need to reflect upon the difficulties facing prescribers, part icularly when prescribing within cash-limited budgets, to avoid discord bet ween prescribing behaviour and local policy development.