The prescribing of specialist medicines: What factors influence GPs' decision making?

Abstract

Background. As Governments worldwide strive to integrate efficient health care delivery across the primary-secondary care divide, particular significance has been placed on the need to understand GPs' prescribing of specialist drugs. Objective. To explore the factors which influence GPs' decision-making process when requested to prescribe specialist drugs. Methods. A qualitative approach was used to explore the perspectives of a wide range of practice-, primary care trust-, strategic health authority-level staff and other relevant stakeholders in the North-West of England. All semi-structured interviews (n = 47) were analysed comprehensively using the five-stage 'framework' approach. Results. Six diverse factors were identified as having a crucial bearing on how GPs evaluate initial requests and subsequently decide whether or not to prescribe. These include GPs' lack of knowledge and expertise in using specialist drugs, the shared care arrangement, the influence of a locally agreed advisory list, financial and resource considerations, patient convenience and understanding and GPs' specific areas of interest. Conclusion. This exploration of GPs' decision-making process is needed to support future integrated health care delivery. © The Author 2009. Published by Oxford University Press. All rights reserved.