Towards understanding treatment preferences of hospital physicians

Denig, Petra; Haaijer‐Ruskamp, Flora; Wesseling, H; Versluis, A.

doi:10.1016/0277-9536(93)90083-g

Cited by 41 publications

(24 citation statements)

References 17 publications

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“…9 In this qualitative study, analysis of the roles and relationships of five health practitioner types revealed a distinct set of social and cultural influences on prescribing in teaching hospitals. This finding is consistent with theories suggesting that prescribers are influenced by a range of factors external to clinical and drug issues.…”

Section: Discussionmentioning

confidence: 99%

Prescribing in Teaching Hospitals: a Qualitative Study of Social and Cultural Dynamics

Page¹,

Bajorek

Brien

2008

Pharmacy Practice and Res

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Background: General practitioners integrate an array of social and environmental factors into their prescribing decisions. In teaching hospitals, despite the involvement of multiple practitioners in making and acting on prescribing decisions, little is known about the influence of roles, relationships, professional subcultures and underlying beliefs, on prescribing practices. Aim: To explore the social and cultural dynamics of prescribing in teaching hospitals. Method: Consultants, registrars, junior doctors, nurses and pharmacists from 2 large Sydney teaching hospitals were sampled purposively and invited to participate in a qualitative study involving semi-structured interviews. The interview topics explored included: attitudes about prescribing, roles and responsibilities, communication of decisions, influences on prescribing and factors contributing to prescribing errors. Interviews were transcribed verbatim and the content analysed thematically. Results: Participants included 8 consultants, 8 registrars, 9 junior doctors, 7 nurses and 11 pharmacists. 5 distinct sets of social and cultural influences on prescribing behaviours were identified. The dominant set of influences related to the structure of how prescribing took place and chief among these were the strong intra-professional relationships of medical teams. Other social and cultural influences related to how prescribing decisions were communicated, underlying assumptions within medical teams, knowledge acquisition and the hospital environment. Conclusion: Prescribing in teaching hospitals is shaped by a complex web of social and cultural dynamics. An appreciation of these influences may be vital to the success of strategies to improve use of medicines in teaching hospitals. J Pharm Pract Res 2008; 38: 286-91.

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Section: Discussionmentioning

confidence: 99%

Prescribing in Teaching Hospitals: a Qualitative Study of Social and Cultural Dynamics

Page¹,

Bajorek

Brien

2008

Pharmacy Practice and Res

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“…This indicates that they made shortcuts and did not necessarily compare treatments explicitly with each other, which is in line with previous findings among medical specialists. [29][30][31][32] There was no consistent influence of the doctors' practice experience on the decision process.…”

Section: Discussionmentioning

confidence: 99%

Scope and nature of prescribing decisions made by general practitioners

Denig

2002

Quality and Safety in Health Care

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Background: This study describes cognitive processes of doctors who are deciding on the treatment for a patient. This helps to uncover how prescribing decisions could benefit from (computerised) support. Methods: While thinking aloud, 61 general practitioners made prescribing decisions for five patients with urinary tract infections or stomach complaints. The resulting 305 transcripts were analysed to determine the scope and nature of the decision processes. Differences in the process were related to case or doctor characteristics, and to differences in the quality of prescribing behaviour. Results: The decision processes were not extensive, particularly for patients with a urinary tract infection. The doctors did not actively consider all possible relevant information. Considerations referring to core aspects of the treatment were made in 159 cases (52%) and to contextual aspects in 111 cases (36%). Habitual behaviour, defined as making a treatment decision without any specific contemplation, was observed in 118 cases (40%) and resulted in prescribing first choice as well as second choice drugs. For stomach complaints, second choice drugs were often prescribed after considering other treatments or in view of specific circumstances. Experience of the doctor was not related to the type of decision process. Conclusions: The processes observed deviate from the decision theoretic norm of thoroughly evaluating all possible options, but these deviations do not always result in suboptimal prescribing. Decision support is useful for bringing pertinent information and first choice treatments to the prescriber's attention. In particular, information about relevant contraindications, interactions, and costs could improve the quality of prescribing.

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“…Prescribing decision making in secondary care has also been studied, using quantitative approaches. A study from the Netherlands showed that the doctors did not only consider the biomedical aspects in their choices of treatment – following the hospital or ward routine was also important, as was the opinion of colleagues and personal experiences [7]. This study presented the doctors with short patient descriptions and asked for treatment preferences for each case.…”

Section: Introductionmentioning

confidence: 99%