Use of new drugs	“They are useful to us in sponsoring medical education whether it's buying books for the department, allowing us to have lunchtime meetings and show films to juniors and occasionally giving me sponsorship to go to things . . . which the NHS won't pay for.”
Usually prescribe new drugs only in their specialty	Contact with GPs was limited
“We should all be very, very conservative about using drugs in fields when one is not an expert.”	“There are 3 or 4 I know quite well, there are a number of others who I sort of bump into maybe once a year and we will say hello to each other, and a fair number who write to me fairly regularly or speak on the phone who I wouldn't recognise their face if we met.”
Prescribe few new drugs	Attitudes to innovation
“I can think of two of them. One is losartan . . . and nicorandil.”	Main reason for using a new drug was usually failure of existing treatment
Information about new drugs	“To give it [venlafaxine] a try with my difficult patients, the way things usually happen”
First hear from variety of sources	Most specialists were cautious about introducing new drugs but this varied partly with the perceived risk
“Drug adverts, glossy adverts in the BMJ or the Lancet or something like that. . . In fact I think they mail- shotted everybody in the world to go to various meetings.”	“I would say I was pretty ready, trying new things appeals to me, most new things I will give a whirl to. . . .I would tend not to use it first line until I had got some experience with it.”
“The [Efexor] rep came . . . and had an appointment with me. I think that yes, you first hear through the reps”	“I am average. I am not one of those people who have to use everything new and I am not so conservative that I will only use them when they have been. . . So I am fairly keen to use things mainly because really we have a lot of areas where we don't have very good drugs.”
“At an international meeting about 5 years ago. We knew that the angiotensin receptor was being investigated . . . I can't remember when I first heard the word losartan but it must be about 3 years ago.”	“There has been no experience of its use among our peers, by ourselves, and therefore when you don't have a feel for something you are very cautious about it . . . nicorandil was a new type of drug as far as the European population was concerned.”
Drug representatives are important source of information	Cost relative to existing treatments was a consideration but was not a major issue
“Normally I would get the most information about the drug from the company representative . . . it's quite useful to pick their brains and to identify any appropriate publications that you might want them to get hold of for you.	“But I think most doctors in hospital, or indeed general practice, I have to say don't really take that much notice of the cost because you have got to have something that helps your patient. It's no good saying we can't spend more than X amount.”
Described a gradual build up of information	Specialists in care of elderly people described their approach as between that of other specialists and GPs
“An increasing number of papers and presentations showing that it was useful in a number of patients and an improvement on the existing treatment.”	“I'd want to know that there was a body of written evidence to support the use. . . I'd want to be sure that my colleague in that particular speciality knew of the drug and was happy to use it.”
Influenced primarily by scientific literature and meetings in own specialty	Give GPs minimum information when requesting them to prescribe a new drug for a patient
“There was one particular paper in the Lancet . . . that was certainly seminal. When I read a paper in the Lancet about the drug, that it's not just quackery, respected people here are actually saying this drug works, so therefore it's worth having a go.”	“I expect a GP to know, if he does not know about it I would expect him to find out more about it really”
Take advice from colleagues outside their specialty
“If it's a drug that is outside my field then I really wouldn't prescribe it until I had talked to the people working in the field, because you get the impression that something sounds wonderful until you talk to the specialty and they will say ‘well, yes it is a good development, but. . .’”
Have a good relationship with drug representatives
“Representatives who I have dealings with come and see me on a regular basis provided they have got something new to talk about. So this was an old friend coming with a new product.”