Skip to main content
NCBI home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1999 Jul 27;161(2):139–142.

Effects of perceived patient demand on prescribing anti-infective drugs

E Miller 1, L D MacKeigan 1, W Rosser 1, J Marshman 1
PMCID: PMC1230462  PMID: 10439821

Abstract

BACKGROUND: Although patient demand is frequently cited by physicians as a reason for inappropriate prescribing, the phenomenon has not been adequately studied. The objectives of this study were to determine the prevalence of perceived patient demand in physician-patient encounters; to identify characteristics of the patient, physician and prescribing situation that are associated 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 Toronto area completed a brief questionnaire for each patient encounter related to suspected infectious disease. Physicians were later asked in an interview to select and describe 1 or 2 incidents from these encounters during which perceived patient demand influenced their prescribing (critical incident technique). RESULTS: Perceived patient demand was reported in 124 (48%) of the 260 physician-patient encounters; however, in almost 80% of these encounters physicians 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 reported that they were influenced either "moderately" or "quite a bit" by perceived patient demand in over 50% of these cases. Of the 35 critical prescribing incidents identified during the interviews, anti-infectives were prescribed 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. Patient demand had more influence on prescribing when physicians were uncertain of the need for an anti-infective.

Full Text

The Full Text of this article is available as a PDF (90.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altmaier E. M., McGuinness G., Wood P., Ross R. R., Bartley J., Smith W. Defining successful performance among pediatric residents. Pediatrics. 1990 Feb;85(2):139–143. [PubMed] [Google Scholar]
  2. Bradley C. P. Uncomfortable prescribing decisions: a critical incident study. BMJ. 1992 Feb 1;304(6822):294–296. doi: 10.1136/bmj.304.6822.294. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Britten N. Patient demand for prescriptions: a view from the other side. Fam Pract. 1994 Mar;11(1):62–66. doi: 10.1093/fampra/11.1.62. [DOI] [PubMed] [Google Scholar]
  4. Britten N., Ukoumunne O. The influence of patients' hopes of receiving a prescription on doctors' perceptions and the decision to prescribe: a questionnaire survey. BMJ. 1997 Dec 6;315(7121):1506–1510. doi: 10.1136/bmj.315.7121.1506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cockburn J., Pit S. Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations--a questionnaire study. BMJ. 1997 Aug 30;315(7107):520–523. doi: 10.1136/bmj.315.7107.520. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Diamond M. R., Kamien M., Sim M. G., Davis J. A critical incident study of general practice trainees in their basic general practice term. Med J Aust. 1995 Mar 20;162(6):321–324. doi: 10.5694/j.1326-5377.1995.tb139913.x. [DOI] [PubMed] [Google Scholar]
  7. Dunn W. R., Hamilton D. D. The critical incident technique--a brief guide. Med Teach. 1986;8(3):207–215. doi: 10.3109/01421598609036857. [DOI] [PubMed] [Google Scholar]
  8. Eddy D. M., Billings J. The quality of medical evidence: implications for quality of care. Health Aff (Millwood) 1988 Spring;7(1):19–32. doi: 10.1377/hlthaff.7.1.19. [DOI] [PubMed] [Google Scholar]
  9. FLANAGAN J. C. The critical incident technique. Psychol Bull. 1954 Jul;51(4):327–358. doi: 10.1037/h0061470. [DOI] [PubMed] [Google Scholar]
  10. Gorton T. A., Cranford C. O., Golden W. E., Walls R. C., Pawelak J. E. Primary care physicians' response to dissemination of practice guidelines. Arch Fam Med. 1995 Feb;4(2):135–142. doi: 10.1001/archfami.4.2.135. [DOI] [PubMed] [Google Scholar]
  11. Hemminki E. Review of literature on the factors affecting drug prescribing. Soc Sci Med. 1975 Feb;9(2):111–116. doi: 10.1016/0037-7856(75)90103-1. [DOI] [PubMed] [Google Scholar]
  12. Hepler C. D., Clyne K. E., Donta S. T. Rationales expressed by empiric antibiotic prescribers. Am J Hosp Pharm. 1982 Oct;39(10):1647–1655. [PubMed] [Google Scholar]
  13. Katz J. Why doctors don't disclose uncertainty. Hastings Cent Rep. 1984 Feb;14(1):35–44. [PubMed] [Google Scholar]
  14. Leape L. L. Unnecessary surgery. Health Serv Res. 1989 Aug;24(3):351–407. [PMC free article] [PubMed] [Google Scholar]
  15. O'Hagan J. J. What influences our prescribing?--Some non-pharmacological issues. N Z Med J. 1984 May 23;97(756):331–332. [PubMed] [Google Scholar]
  16. Schwartz R. K., Soumerai S. B., Avorn J. Physician motivations for nonscientific drug prescribing. Soc Sci Med. 1989;28(6):577–582. doi: 10.1016/0277-9536(89)90252-9. [DOI] [PubMed] [Google Scholar]
  17. Stimson G. V. Doctor-patient interaction and some problems for prescribing. J R Coll Gen Pract. 1976;26 (Suppl 1):88–96. [PMC free article] [PubMed] [Google Scholar]
  18. Virji A., Britten N. A study of the relationship between patients' attitudes and doctors' prescribing. Fam Pract. 1991 Dec;8(4):314–319. doi: 10.1093/fampra/8.4.314. [DOI] [PubMed] [Google Scholar]
  19. Webb S., Lloyd M. Prescribing and referral in general practice: a study of patients' expectations and doctors' actions. Br J Gen Pract. 1994 Apr;44(381):165–169. [PMC free article] [PubMed] [Google Scholar]
  20. Williamson J. A., Webb R. K., Pryor G. L. Anaesthesia safety and the "critical incident" technique. Aust Clin Rev. 1985 Jun;(17):57–61. [PubMed] [Google Scholar]
  21. Wright D., Mackenzie S. J., Buchan I., Cairns C. S., Price L. E. Critical incidents in the intensive therapy unit. Lancet. 1991 Sep 14;338(8768):676–678. doi: 10.1016/0140-6736(91)91243-n. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES