Table 3.

Themes and Subthemes from Interviews

Theme 1: Perception that Veterans routinely expect a medication from their visit, despite clinical appropriateness There is a pressure to “do something” that frequently involves providing a prescription and may be contrary to clinical appropriateness Potential outside influences that contribute to medication expectation Workload and patient satisfaction may suffer if a prescription is not provided Veterans do not expect a medication, they want to get better

Theme 2: A frequently hectic clinical environment and unique practice conditions in unscheduled settings provided little time to focus on prescribing practices Time pressured environment provides little time to focus on prescribing Unique practice conditions making a clinician’s patients “different” Practice norms impact prescribing behavior

Theme 3: Clinician knowledge, awareness, and willingness to use evidence-based care Lack of clinician awareness of potential comorbidities and drug interactions Clinician willingness to change behavior

Theme 4: Uncertainty about whether an adverse event will occur Challenges in knowing whether a Veteran’s condition would be appropriate for an NSAID Prescribing antibiotics “out of fear” to prevent adverse events

Theme 5: Inadequate communication during and after the clinical encounter Limited communication with primary care Lack of post-encounter feedback Veteran communication preferences during the clinical encounter about medication information Lack of Veteran interest in handouts, posters, and web sites

Theme 6: Technology barriers limited the usefulness of clinical decision support and patient communication Electronic health record pop-up fatigue Challenges access the Veteran patient portal, MyHealtheVet