How do physicians decide which drug to prescribe

Phone: Toll-free: Ext. Improving your prescribing practice CPSA believes in a quality improvement approach to prescribing that involves collaboration between physicians, CPSA team members and others with expertise in prescribing practices.

Review the rules for physician participation in CPSA's prescribing program. Our vision is to empower prescribers to provide the safest and most appropriate care to their patients by using data and evidence-based approaches, and to actively support patient-centered care, continuous quality improvement and interdisciplinary collaboration.

What is the purpose of CPSA's prescribing program? Can a prescription be faxed to the pharmacy? Can a prescription have an electronic signature? Direct authorization by valid signature is required to verify the authenticity of prescriptions. Can a physician provide a new prescription for a patient without seeing that patient? Does CPSA allow physicians to authorize cannabis for medical purposes?

The cornerstones of concordance include:. They advocate a non-judgemental discussion in which the patient's perceptions and preferences are explored. These two types can overlap. See also the separate Prescribing Issues and Concordance article. The GMC recommends that, as a general rule, you should avoid treating yourself, your family or persons with whom you have a close relationship.

In their Good Practice guidelines, they specifically state that: 'Controlled drugs can present particular problems, occasionally resulting in a loss of objectivity leading to drug misuse and misconduct.

You must record your actions and be able to justify them as well as record the circumstances that led to the situation.

You must also inform that person's own GP unless they object. It is incumbent on anybody prescribing medicines to keep up to date with the ongoing developments and ensure that your prescription is appropriate [ 1 ]. There are many sources of information to support which include:.

Pharmacist Schools. Good practice in prescribing and managing medicines and devices ; General Medical Council, February Ther Clin Risk Manag. Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence ; NICE Clinical Guideline January Electronic Medicines Compendium eMc.

Medicines guidance and prescribing support from NICE. Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions.

Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.

For details see our conditions. This article is for Medical Professionals. In this article Introduction Prescribing guidance Particular patient groups Difficulties with prescriptions Other issues. Introduction When prescribing, there are a number of points to take into account. Are you protected against flu? There were similarities but also many differences between the countries. Clinical effectiveness is the most important factor considered in drug prescription choice in both countries.

Greek physicians were significantly more likely to take additional criteria under consideration, such as the drug form and recommended daily dose and the individual patient preferences. The list of main sources of information for physicians includes: peer-reviewed medical journals, medical textbooks, proceedings of conferences and pharmaceutical sales representatives.

Only half of prescribers considered the cost carried by their patients. The majority of doctors in both countries agreed that the effectiveness, safety and efficacy of generic drugs may not be excellent but it is acceptable.

However, only Cypriot physicians actually prescribe them. Physicians believe that new drugs are not always better and their higher prices are not necessarily justified. Finally, doctors get information regarding adverse drug reactions primarily from the National Organisation for Medicines. However, it is notable that the majority of them do not inform the authorities on such reactions. The present study highlights the attitudes and the factors influencing physician behaviour in the two countries and may be used for developing policies to improve their choices and hence to increase clinical and economic effectiveness and efficiency.

Peer Review reports. Over the past few decades, pharmaceutical expenditure has risen rapidly in most western countries and this has been a reason for concern to policymakers, who have reacted with healthcare reforms and measures to guarantee the sustainability of their health care systems [ 1 ]. It is notable however that it grows, in real terms, by 4. Alongside the concern regarding the growth of pharmaceutical expenditure, there is also a increasing concern regarding irrational, inappropriate, or sometimes even harmful prescribing [ 3 , 4 ].

The latter matter has two manifestations. On the one hand, there is plenty of evidence from observational or experimental studies that, for several reasons many of which have been identified, eligible patients are not always prescribed the pharmaceutical therapies indicated for their condition.

On the other hand, there is also evidence about over and misuse of pharmaceutical products. The consequence of the above can be the loss of health and quality of life benefit for patients and society and the increase of health care expenditure [ 5 ].

Thus, for health and economic reasons, it is important to follow the recommended optimal and established drug prescription guidelines. In this context, a lot of research is trying to analyse and to understand the factors which influence physician prescribing decisions and practice. The related literature suggests several factors that may have a role in influencing the prescribing behaviour of physicians [ 6 — 9 ].

Some factors are fixed and they do not offer any opportunity for modification and improvements in prescribing behaviour.

Such factors for instance include, the age and sex of the physician or the patient, the socio-economic characteristics of the practicing area or the reimbursement status of therapy [ 10 , 11 ]. On the other hand, there are factors which can be influenced and in turn cause a modification to the prescribing behaviour of physicians.

Such factors may be the under and post graduate education and the experience of the physician, various social factors, the number of practitioners in a practice and others [ 12 — 15 ]. It is notable that no other study has attempted so far to analyse the prescribing behaviour and its determinants amongst Greek or Cypriot primary care physicians.

Therefore, we carried out a survey in order to investigate the prescribing attitudes of physicians in these two countries and in the present paper we present the main survey results. The paper outlines in a comparative and detailed way the main factors influencing the decision making and the drug prescription choices of physicians in the two countries. More specifically, it reveals the criteria which justify prescription choice, the sources of physician information, the attitudes towards generic or new innovative drugs, the importance of the drug cost in the decision, etcetera.

This information can help policy makers to identify the measures needed to improve the effectiveness of health policy and consequently it can contribute towards a greater economic and clinical efficiency and effectiveness in the two countries under consideration. The Greek health care system has characteristics from both the Beveridge Social Security and the Bismarck Social Insurance health organisation model.

Specifically, a National Health Service NHS was established in , with the aim to provide on behalf of the state health care services to all citizens. In this context, services are provided by public secondary and tertiary care hospitals and by primary care units, which are located in semi-urban and rural areas.

There are also a few thousand primary care physicians doing after graduation compulsory training in rural areas. However, it is notable that the Sickness Funds also operate on their own several primary care health units and hospitals.

Finally, alongside the above there is a significant in size private health care sector, comprising freelancing or contracted physicians, diagnostic centres and hospitals. There are no general practitioners, to act as gatekeepers to the healthcare system in Greece. Thus, regarding their health problem, patients can consult with any physician within the primary or secondary health care system.

In Cyprus healthcare delivery depends on both public and private health units as well. The public sector is mostly responsible for the provision of secondary and tertiary care and the private sector is responsible for the provision of primary health care services.

It is notable that in this country as well there is no gate-keeping system at present, meaning that patients are free to select and consult with any physician of their choice [ 16 ]. A questionnaire was developed by the Department of Health Economics at the National School of Public Health in Greece, specifically for the purposes of the survey.

The questionnaire is divided into seven different sections: the first is designed to investigate the determinants of physician prescribing behaviour and their main sources of information; the second reflects their opinion about the cost of pharmaceuticals to the patient; the third section focuses on attitudes towards the prescription of generics; the fourth section reflects attitudes towards new pharmaceutical products; the fifth section is about adverse drug reactions and safety; the sixth section focuses on pharmaceutical company sales representatives; and the last section includes questions about the demographic characteristics of the person answering.

In total, the questionnaire included 47 semi-closed questions. It was piloted to a group of physicians in Greece in the period between the November of and January of The physicians who participated in the pilot study made significant comments towards the improvement of the instrument and all of their recommendations were taken into consideration and were incorporated in the final questionnaire. The proportional stratified sampling technique was used to draw a sample, on the basis of physician geographical region, specialty and sex.

Excluded from the sample were physicians who were not authorised to prescribe, either because they were still interns or because they belonged to a specialty that is not permitted to prescribe radiology, nuclear medicine, microbiology, haematology, anaesthesiology, forensic medicine.

In Greece, a sample of 1, physicians was randomly selected for the purpose of the study and in Cyprus the questionnaire was sent to physicians also randomly selected in a similar manner. In both countries, the final questionnaire, a cover letter and a prepaid return envelope were mailed to the physicians from the 1 st of April to the 30 th of May The study is non interventional and it does not involve patients and hence no ethical approval was needed.

Nonetheless, it was undertaking according to the ethical standards and procedures set for this type of research in both countries and academic institutions involved. Written information was of limited importance except for local guidelines. GPs were largely reactive and opportunistic recipients of new drug information, rarely reporting an active information search. Prescribing of new drugs is not simply related to biomedical evaluation and critical appraisal but, more importantly, to the mode of exposure to pharmacological information and social influences on decision making.

Viewed within this broad context, prescribing variation becomes more understandable. Findings have implications for the implementation of evidence-based medicine, which requires a multifaceted approach. Family Practice ; 61— Choosing a medicine for a patient is a key task for doctors.

Why doctors decide to adopt a new medicine is often unclear. UK doctors are said to be therapeutically conservative, and uptake of new drugs is slower in the UK than in other European countries, a matter of praise by some 1 and criticism by others.

Most attempts to explain decision making in prescribing have been based on information processing, 3 considering drug attributes and outcomes, while overlooking the importance of psychosocial influence. These factors, such as doctor characteristics, 4 hospital consultants, 5 the pharmaceutical industry 6 and patient factors, 7 lie behind much of that variation in prescribing among GPs which is not explained by morbidity.

Much prescribing research has been quantitative, but recent qualitative research has helped our understanding by identifying the factors that GPs report as important.

By focusing on a specific range of new drugs, the aims of this study are 2-fold: to document the factors that influence GPs to prescribe a new drug for the first time; and to explore the nature and underlying processes of decision making in new drug prescribing.

A list of new drugs launched between January and May and which might be used in primary care was compiled see Table 1. The intention was to interview as many GPs as possible from each chosen practice.

All GPs from identified practices were invited to participate by letter and followed-up with a telephone call 1—2 weeks later. Towards the end of interviewing, no new themes emerged, indicating that a comprehensive spectrum of factors had been identified. One researcher HP conducted interviews between August and February The critical incident technique 11 was used to encourage doctors to give factual accounts of prescribing events and to describe why they had prescribed a new drug.

For each drug prescribed, doctors were asked about:. Interviews were tape-recorded and transcribed. Content analysis with systematic and comprehensive coding was first employed to identify categories of reasons for prescribing.

The data were examined repeatedly until all cited influences were coded in terms of these categories. This gave an indication of the relative frequency of factors influencing new drug initiation.

Transcripts were analysed independently by the three researchers, who then compared emergent themes and categories. Discrepancies were discussed before final categorization and conceptualization was agreed. Eleven GPs practised single handedly and eight were from dispensing practices.

Of the 19 drugs that fitted the criteria, three had not been prescribed by any GP. Only one GP had not prescribed any of the drugs.

Factors influencing the decision to prescribe a drug were categorized broadly into:. These were not analysed further. Internal choice—incidents wherein the prescribing was not initiated by a third party. These were the subject of the present analysis. The significant first stage in the decision-making process is awareness of a new drug. The most important sources Table 2 were the pharmaceutical industry, in particular the company representative, non-peer-reviewed literature, the mass media largely the reporting of sildenafil and, to a lesser extent, hospital colleagues.

Peer-reviewed literature or independent drug information sources were rarely significant at this stage. Most prescribing decisions were multifactoral. The most frequently cited biomedical influences were the failure of current therapy and adverse effect profile of alternative medicines. Decisions to initiate a new drug were influenced by its perceived economic or pharmacological advantages reasons over alternatives; however, in incidents, the new drug was prescribed because treatment with first-choice drugs in a patient had been suboptimal.

Mentioned more frequently, however, was the pharmaceutical industry, specifically the representative. Colleagues, especially in hospital, and also nurses were next most important. In cases, initial information was considered inadequate and the GP used additional evidence or opinion before prescribing.

However, exposure to new drug information tended to be reactive, implicit and ad hoc. The pharmaceutical industry was the prime mover here in incidents, especially the representative incidents. Although the availability of new cheaper alternatives influenced prescribing, the relatively high cost of some new drugs militated against it, so GPs often adopted a stepwise approach, trying familiar cheaper alternatives first, and only using new more expensive drugs if this failed or caused adverse effects.

However, GPs did not hesitate to use a more costly drug perceived to have significant clinical advantage, or in response to patient requests. We identified three domains of evidence that GPs considered in evaluating new drugs: i information source, i. The pharmaceutical industry was the most frequently used information source and there was an evident association between the evidence distilled from representatives and prescribing initiation.

Although GPs questioned the objectivity of the industry, they generally considered its information to be factually accurate, if selective. Of particular note is the lack of recourse to scientific research and evidence-based sources.