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Quality & Safety in Health Care logoLink to Quality & Safety in Health Care
. 2003 Feb;12(1):29–34. doi: 10.1136/qhc.12.1.29

Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey

C Watkins 1, I Harvey 1, P Carthy 1, L Moore 1, E Robinson 1, R Brawn 1
PMCID: PMC1743655  PMID: 12571342

Abstract

Background: General practitioner (GP) prescribing accounts for about 10% of NHS expenditure. GPs at the top of the range have annual prescribing costs that are almost twice as much as those at the bottom of the range. This variation cannot be accounted for purely in terms of differences in underlying need for health care.

Objectives: To describe the relationship between GPs' prescribing costs and their attitudes towards prescribing decisions and prescribing information sources, and to identify potentially modifiable attitudinal and behavioural factors associated with high cost prescribing.

Design: A postal questionnaire was designed on the basis of hypotheses developed from a literature search and an earlier qualitative survey. This questionnaire was sent to a national sample of GPs with equal numbers of practices in the upper, middle, and lowest quintile of prescribing costs.

Setting: GP practices in England.

Participants: 1714 GPs in NHS practice.

Outcome measures: GPs' self-reported practices, attitudes and personal characteristics.

Results: There was a 64% response rate. Responders were more likely to be from larger practices, in less deprived areas, and with lower prescribing costs than were non-responders. Multivariable analysis showed that GPs with high prescribing costs were significantly more likely to work in dispensing practices, in practices with low income populations, in single handed practices, and in practices without a GP trainer. They were also significantly more likely to see drug company representatives more frequently, to prescribe newly available drugs more freely, to prescribe more readily to patients who expect a prescription, to report high levels of frustration from lack of time in the consultation, to find unsatisfactory those consultations which ended in advice only, and to express dissatisfaction with their review methods for repeat prescribing. They were significantly less likely to find useful criticism of prescribing habits by colleagues, and to check the BNF rather than other sources when uncertain about an aspect of drug treatment.

Conclusions: While they cannot be held to have a causal relationship, the pattern of attitudes towards prescribing of GPs in the highest quintile of prescribing costs provide the basis for developing an educational intervention which may be an acceptable method of modifying the attitudes of GPs and consequently reducing their prescribing costs.

Full Text

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Selected References

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

  1. Avery A. J., Wetzels R. V., Rodgers S., O'Neill C. Do GPs working in practice with high or low prescribing costs have different views on prescribing cost issues? Br J Gen Pract. 2000 Feb;50(451):100–104. [PMC free article] [PubMed] [Google Scholar]
  2. Baker D., Klein R. Explaining outputs of primary health care: population and practice factors. BMJ. 1991 Jul 27;303(6796):225–229. doi: 10.1136/bmj.303.6796.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Becker M. H., Stolley P. D., Lasagna L., McEvilla J. D., Sloane L. M. Correlates of physicians' prescribing behavior. Inquiry. 1972 Sep;9(3):30–42. [PubMed] [Google Scholar]
  4. Bradley C. P. Factors which influence the decision whether or not to prescribe: the dilemma facing general practitioners. Br J Gen Pract. 1992 Nov;42(364):454–458. [PMC free article] [PubMed] [Google Scholar]
  5. Carrin G. Drug prescribing: a discussion of its variability and (ir)rationality. Health Policy. 1987 Feb;7(1):73–94. doi: 10.1016/0168-8510(87)90048-0. [DOI] [PubMed] [Google Scholar]
  6. Carthy P., Harvey I., Brawn R., Watkins C. A study of factors associated with cost and variation in prescribing among GPs. Fam Pract. 2000 Feb;17(1):36–41. doi: 10.1093/fampra/17.1.36. [DOI] [PubMed] [Google Scholar]
  7. Caudill T. S., Johnson M. S., Rich E. C., McKinney W. P. Physicians, pharmaceutical sales representatives, and the cost of prescribing. Arch Fam Med. 1996 Apr;5(4):201–206. doi: 10.1001/archfami.5.4.201. [DOI] [PubMed] [Google Scholar]
  8. Forster D. P., Frost C. E. Use of regression analysis to explain the variation in prescribing rates and costs between family practitioner committees. Br J Gen Pract. 1991 Feb;41(343):67–71. [PMC free article] [PubMed] [Google Scholar]
  9. Hartley R. M., Charlton J. R., Harris C. M., Jarman B. Patterns of physicians' use of medical resources in ambulatory settings. Am J Public Health. 1987 May;77(5):565–567. doi: 10.2105/ajph.77.5.565. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Healey A. T., Yule B. F., Reid J. P. Variations in general practice prescribing costs and implications for budget setting. Health Econ. 1994 Jan-Feb;3(1):47–56. doi: 10.1002/hec.4730030107. [DOI] [PubMed] [Google Scholar]
  11. Howie J. G. Clinical judgement and antibiotic use in general practice. Br Med J. 1976 Oct 30;2(6043):1061–1064. doi: 10.1136/bmj.2.6043.1061. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lloyd D. C., Harris C. M., Clucas D. W. Low income scheme index: a new deprivation scale based on prescribing in general practice. BMJ. 1995 Jan 21;310(6973):165–169. doi: 10.1136/bmj.310.6973.165. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Morton-Jones T., Pringle M. Explaining variations in prescribing costs across England. BMJ. 1993 Jun 26;306(6894):1731–1734. doi: 10.1136/bmj.306.6894.1731. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Peay M. Y., Peay E. R. Differences among practitioners in patterns of preference for information sources in the adoption of new drugs. Soc Sci Med. 1984;18(12):1019–1025. doi: 10.1016/0277-9536(84)90160-6. [DOI] [PubMed] [Google Scholar]
  15. Roberts S. J., Harris C. M. Age, sex, and temporary resident originated prescribing units (ASTRO-PUs): new weightings for analysing prescribing of general practices in England. BMJ. 1993 Aug 21;307(6902):485–488. doi: 10.1136/bmj.307.6902.485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Rodgers S., Avery A. J., Meechan D., Briant S., Geraghty M., Doran K., Whynes D. K. Controlled trial of pharmacist intervention in general practice: the effect on prescribing costs. Br J Gen Pract. 1999 Sep;49(446):717–720. [PMC free article] [PubMed] [Google Scholar]
  17. Ryan M., Yule B., Bond C., Taylor R. J. Scottish general practitioners' attitudes and knowledge in respect of prescribing costs. BMJ. 1990 May 19;300(6735):1316–1318. doi: 10.1136/bmj.300.6735.1316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. 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]
  19. van Zwanenberg T. D., Grant G. B., Gregory D. A. Can rational prescribing be assessed? J R Coll Gen Pract. 1987 Jul;37(300):308–310. [PMC free article] [PubMed] [Google Scholar]

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