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Secondary care doctors' perception of appropriate prescribing
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
2009 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 1, 110-115 p.Article in journal (Refereed) Published
Abstract [en]

RATIONALE, AIM AND OBJECTIVE: As the prescribing of drugs in secondary care is known to influence prescribing in primary care and because an understanding of prescribers' reasoning is essential for evaluating prescribing appropriateness, the aim of this study was to investigate secondary care doctors' views of appropriate prescribing, using qualitative individual interviews. METHOD: Qualitative, semi-structured individual interviews were conducted with 15 hospital doctors working in different medical specialities. The interviews, covering the doctors' views of the meaning of 'appropriate' prescribing, were audiotaped and analysed from an interpretivist perspective. RESULTS: Three different main themes were identified in the analysis of how the doctors perceived appropriate prescribing: 'individualization of treatment', 'cost' and 'time'. Most importantly, treatment should be adjusted to the individual patient, although cost should also be justified. Ongoing medication reviews should be carried out, to adjust to changes in patient-related factors over time. CONCLUSIONS: The hospital doctors brought up continuous review as a necessary part of appropriate prescribing. Thus, from the prescribers' point of view, this time perspective should be explicitly incorporated in definitions of appropriate prescribing, in addition to individualization of treatment and cost considerations.

Place, publisher, year, edition, pages
2009. Vol. 15, no 1, 110-115 p.
Keyword [en]
doctors, drug therapy, drug utilization review, hospital, prescribing, qualitative research
National Category
Pharmaceutical Sciences
URN: urn:nbn:se:uu:diva-101032DOI: 10.1111/j.1365-2753.2008.00963.xISI: 000263337200015PubMedID: 19239590OAI: oai:DiVA.org:uu-101032DiVA: diva2:211584
Available from: 2009-04-16 Created: 2009-04-16 Last updated: 2013-01-17Bibliographically approved
In thesis
1. Prerequisites and Responsibility for Appropriate Prescribing - the Prescribers' View
Open this publication in new window or tab >>Prerequisites and Responsibility for Appropriate Prescribing - the Prescribers' View
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to explore aspects of the subjective views and experiences of doctors as prescribers, focusing on responsibility for and factors of importance in achieving appropriate prescribing. To provide insights into the prescriber’s perspective the study designs were qualitative.

In the first studies secondary care doctors’ perceptions of appropriate prescribing and influences in prescribing were investigated in interviews. The doctors perceived that appropriate prescribing needed continuous revision. From the perspective of the prescribers the definition of prescribing could be rephrased as: “the outcome of the recurring processes of decision making that maximises net individual health gains within society’s available resources”. Among the influences in prescribing were guidelines, colleagues and therapeutic traditions.

In the subsequent studies the experiences of exchanging information regarding a patient’s drugs in an electronic patient medical record (e-PMR) shared between primary and secondary care and views of responsibility was explored, using focus groups with both primary and secondary care doctors. Considering the gap between health care levels, doctors’ views of responsibility in prescribing and exchange of information are of concern.

The doctors expressed how they assume information to be in the e-PMR and active information transfer has decreased. On the other hand, they experienced an information overload in the e-PMR system. There is a need for improved and structured communication between health-care givers. Taking responsibility to review all the patient’s medications was perceived as important, but described as still not done. Lack of responsibility taken was often due to acts of omission, i.e. that doctors did not make needed changes to the list of medications due to different barriers. The barriers rested both with individual doctors and the system, but to ensure solutions that are realisable in practise, perspectives of the doctors need to be taken into consideration when overcoming those barriers.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 81 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 131
computer-assisted drug therapy, prescription drugs, physician’s practice patterns, drug prescriptions, computerised medical records systems, continuity of patient care, hospital medication systems, drug utilisation review, responsibility
National Category
Social and Clinical Pharmacy
Research subject
Social Pharmacy
urn:nbn:se:uu:diva-132544 (URN)978-91-554-7920-6 (ISBN)
Public defence
2010-12-04, B11-105, Biomedicinskt Centrum, Husargatan 3, Uppsala, 09:15 (English)
Available from: 2010-11-12 Created: 2010-10-21 Last updated: 2011-01-13

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