Pressures on the general practitioner and decisions to prescribe.

OBJECTIVES This study examined the extent to which four broad areas of concern associated with prescribing are perceived by general practitioners (GPs): their sense of burden in providing health care, their views on financial constraints and incentives, the use of a prescription to cope with clinical workload and their perception of demanding patients. A secondary aim was to relate these concerns to actual measures of prescribing behaviour using PACT data. METHOD A questionnaire covering the four themes was sent to 386 GPs. Using factor analysis, new measures were constructed to reflect the GPs' perception of the four areas of concern. RESULTS A total of 228 GPs (59%) completed the questionnaire. Results indicated a high level of concern among GPs regarding current pressures that could affect prescribing. Only the respondents' concern about the possible adverse effects of financial pressures upon medical decisions was related to prescribing: those concerned about financial pressures prescribed less generically (P < 0.0005), had higher practice costs compared with the Family Health Services Authority average (P = 0.002) and issued more prescriptions overall (P = 0.007). CONCLUSION There is a continuing need to monitor and evaluate the effect of recent changes in primary care for their effect upon prescribing behaviour.

[1]  L Lasagna,et al.  Prescribing patterns of physicians. , 1969, Journal of chronic diseases.

[2]  P. Curran.  REVIEW BODY ON DOCTORS' AND DENTISTS' REMUNERATION , 1980, The Lancet.

[3]  P. Toon,et al.  Appropriate prescribing in asthma and its related cost in east London. , 1995, BMJ.

[4]  C. Cooper,et al.  Job stress, satisfaction, and mental health among general practitioners before and after introduction of new contract. , 1992, BMJ.

[5]  C P Bradley,et al.  Uncomfortable prescribing decisions: a critical incident study. , 1992, BMJ.

[6]  D. Heaney,et al.  General practice fundholding: observations on prescribing patterns and costs using the defined daily dose method. , 1993, BMJ.

[7]  J. Howie.  Clinical judgement and antibiotic use in general practice. , 1976, British medical journal.

[8]  A Coulter,et al.  Effect of fundholding and indicative prescribing schemes on general practitioners' prescribing costs. , 1993, BMJ.

[9]  J. Forbes,et al.  Quality and the use of time in general practice: widening the discussion. , 1989, BMJ.

[10]  G. Norman,et al.  Factors influencing antibiotic use in acute respiratory tract infections in family practice. , 1988, Canadian family physician Medecin de famille canadien.

[11]  S. Handysides.  Enriching Careers in General Practice: Morale in general practice: is change the problem or the solution , 1994, BMJ.

[12]  C. Bradley,et al.  Factors which influence the decision whether or not to prescribe: the dilemma facing general practitioners. , 1992, The British journal of general practice : the journal of the Royal College of General Practitioners.

[13]  H. Boothby,et al.  Rational prescribing Takes time , 1994 .

[14]  L. Dillner,et al.  Doctors are more miserable than ever, says report , 1994, BMJ.

[15]  M. Pringle,et al.  Explaining variations in prescribing costs across England. , 1993, BMJ.

[16]  S. Iliffe,et al.  General practitioners and incentives. , 1993, BMJ.

[17]  L. Cronbach.  Coefficient alpha and the internal structure of tests , 1951 .

[18]  D. Keeley.  The fundholding debate: should practices reconsider the decision not to fundhold? , 1993, BMJ.

[19]  J. Gilley.  Towards rational prescribing , 1994, BMJ.

[20]  R. Crisp,et al.  "Not clinically indicated": patients' interests or resource allocation? , 1993, BMJ.

[21]  I. Allen.  Doctors and Their Careers , 1988 .

[22]  J. Chaggar.  Citizens' advice in general practice. A burden GPs could do without. , 1993, British medical journal.

[23]  D. Altman,et al.  Multiple significance tests: the Bonferroni method , 1995, BMJ.