Abstract
BACKGROUND: Shared care schemes have mainly centred on chronic diseases, such as asthma and diabetes. However, with increasing government emphasis on primary and secondary care integration and the effects of budget restraints, general practitioners (GPs) have been asked to take on the prescribing of specialist medicines. AIM: To elicit the views and experiences of GPs and hospital doctors about existing arrangements for shared care applied to the prescribing of specialist medicines. To identify a set of quality indicators for prescribing specialist medicines at the interface between primary and secondary care. DESIGN OF STUDY: A qualitative study based on semi-structured interviews. SETTING: Forty-eight GPs and 13 hospital doctors in the former South Thames region. METHOD: The interviews focused on how far experiences with shared care compare with the arrangements currently in place for prescribing specialist medicines and identified the barriers to facilitators of effective shared care. RESULTS: A number of key themes were identified and these formed the basis for eight quality indicators relating to the prescribing of specialist medicines where treatment is shared between primary and secondary care. The themes centred around issues of clinical responsibility, 'cost-shifting', availability of medicines, GP satisfaction, and the nature of the prescribing relationship. CONCLUSION: Overall, GPs appeared dissatisfied with arrangements for prescribing specialist medicines, while hospital doctors were generally satisfied. The quality indicators will form the basis of a more extensive quantitative survey of GPs' perceptions of the arrangements for prescribing specialist medicines.
Full Text
The Full Text of this article is available as a PDF (77.4 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Booth C. M., Chaudry A. A., Smith K., Griffiths K. The benefits of a shared-care prostate clinic. Br J Urol. 1996 Jun;77(6):830–835. doi: 10.1046/j.1464-410x.1996.00810.x. [DOI] [PubMed] [Google Scholar]
- Bull M. GP obstetrics: making the most of shared care. Practitioner. 1989 Feb 22;233(1463):211–215. [PubMed] [Google Scholar]
- Hoskins P. L., Fowler P. M., Constantino M., Forrest J., Yue D. K., Turtle J. R. Sharing the care of diabetic patients between hospital and general practitioners: does it work? Diabet Med. 1993 Jan-Feb;10(1):81–86. doi: 10.1111/j.1464-5491.1993.tb02001.x. [DOI] [PubMed] [Google Scholar]
- McGhee S. M., McInnes G. T., Hedley A. J., Murray T. S., Reid J. L. Coordinating and standardizing long-term care: evaluation of the west of Scotland shared-care scheme for hypertension. Br J Gen Pract. 1994 Oct;44(387):441–445. [PMC free article] [PubMed] [Google Scholar]
- Sibbald B., Wilkie P., Raftery J., Anderson S., Freeling P. Prescribing at the hospital-general practice interface. II: Impact of hospital outpatient dispensing policies in England on general practitioners and hospital consultants. BMJ. 1992 Jan 4;304(6818):31–34. doi: 10.1136/bmj.304.6818.31. [DOI] [PMC free article] [PubMed] [Google Scholar]