Qualitative insights into general practitioners' views on the appropriateness of their long-term prescribing

Abstract

Objective - To explore factors which may contribute to inappropriate long-term prescribing in United Kingdom general practice. Methods - Nine previously validated indicators of the appropriateness of long-term prescribing were applied to a sample of patients, each under the care of one of 22 general practitioners from 10 practices. The GPs were then interviewed, using as the basis for the discussion specific examples of their prescribing that had been identified as potentially inappropriate. The interview transcripts were studied repeatedly to identify key themes in the reasons or explanations for apparently inappropriate prescribing. Setting - General practices in three health authorities in England and one health board in Scotland. Key findings - In total, 227 instances of potentially inappropriate prescribing, relating to 101 patients, were discussed with the 22 GPs. Four key themes emerged from the interview data. One common theme was that of perceived patient preference to continue with long-term therapy. A second theme was cases where the prescribing was 'historical,' ie, the drug had been started a long time before, or by another doctor. Within this context, many doctors expressed great reluctance to change a drug when there was no obvious clinical need to do so, even though they would not initiate the drug regimen within their current practice. A third theme was that 'hospital-led' prescribing was perceived to pose frequent and sometimes potentially difficult problems. Fourth, many GPs expressed their unease with the process of repeat prescribing which is operated in many UK practices. Conclusions - This study has reinforced the fact that there are a number of internal and external factors which can impact on a GP's decision to continue apparently inappropriate long-term prescribing.