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Hospital doctors' views of factors influencing their 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.
2007 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 13, no 5, 765-771 p.Article in journal (Refereed) Published
Abstract [en]

Rationale, aim and objective Factors influencing doctors in prescribing of drugs have mostly been studied in primary care. Studies performed in hospital care have primarily focused on new drugs, not prescribing in general. An in-depth understanding of the prescribing process in the more specialized secondary care is not only important for secondary care itself, but because it also influences prescribing in primary care. The aim of this study is therefore to identify factors that secondary care doctors believe influence them in prescribing drugs, using a qualitative approach.

Method Semi-structured interviews were conducted with 15 hospital doctors in different medical specialities and the interviews were analysed from an interpretivist perspective. The information gathered was on how prescribing decisions were made in general and how the doctors chose a specific drug therapy, including information sources used.

Results According to our interviews, the hospital doctors took patient-specific factors and cost into consideration when prescribing, informed by different written information sources and commercial verbal information. Personal practice, colleagues and therapeutic tradition at the hospital or clinic, were influential in the prescribing of drugs. The themes identified should not to be seen as individual influences; many of them probably act in combination.

Conclusions If changes in prescribing behaviour are desired, factors warranting more attention include understanding how to influence therapeutic traditions and the doctor's personal habits for prescribing. The importance of clinical experience and information exchange with colleagues should not be underestimated in providing information about drugs to hospital doctors.

Place, publisher, year, edition, pages
2007. Vol. 13, no 5, 765-771 p.
Keyword [en]
doctor, hospital, interview, prescribing, qualitative, secondary care
National Category
Pharmaceutical Sciences
URN: urn:nbn:se:uu:diva-11408DOI: 10.1111/j.1365-2753.2006.00751.xISI: 000249253700010PubMedID: 17824870OAI: oai:DiVA.org:uu-11408DiVA: diva2:39177
Available from: 2007-09-12 Created: 2007-09-12 Last updated: 2011-01-21Bibliographically 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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Ljungberg, ChristinaKettis Lindblad, ÅsaTully, Mary
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