A case study on the substitution effect between the length of GP consultation and drug prescribing practices

Abstract

The relationship between the length of GP consultation in primary care and drug prescribing practices is still a subject for debate. Patients' morbidity, generating both very long consultation times and large volumes of prescriptions, may mask an underlying substitution among GPs regarding the length of time they offer to patients versus the alternative of prescribing pharmaceuticals. We propose to pursue the debate by analyzing the results of a case vignette, submitted to 1,900 GPs, in which patient morbidity is controlled for by definition. In this case - a hypothetical patient suffering from mild depression - we observe the choice between three types of treatment strategy: psychotherapy, drug therapy and a combination of the two. We observe that the GPs with the highest consultation rates were twice as likely to adopt the drug therapy option as their counterparts with lower rates of consultation. Moreover, for more than 50% of drug prescriptions, the medical decisions contradict clinical practice guidelines.