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Healthy Skepticism Library item: 2137

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Watkins C, Harvey I, Carthy P, Moore L, Robinson E, Brawn R.
Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey.
Qual Saf Health Care 2003 Feb; 12:(1):29-34
http://qhc.bmjjournals.com/cgi/content/full/12/1/29


Abstract:

BACKGROUND: General practitioner (GP) prescribing accounts for about 10% of NHS expenditure. GPs at the top of the range have annual prescribing costs that are almost twice as much as those at the bottom of the range. This variation cannot be accounted for purely in terms of differences in underlying need for health care.

OBJECTIVES: To describe the relationship between GPs’ prescribing costs and their attitudes towards prescribing decisions and prescribing information sources, and to identify potentially modifiable attitudinal and behavioural factors associated with high cost prescribing.

DESIGN: A postal questionnaire was designed on the basis of hypotheses developed from a literature search and an earlier qualitative survey. This questionnaire was sent to a national sample of GPs with equal numbers of practices in the upper, middle, and lowest quintile of prescribing costs.

SETTING: GP practices in England.

PARTICIPANTS: 1714 GPs in NHS practice.

OUTCOME MEASURES: GPs’ self-reported practices, attitudes and personal characteristics.

RESULTS: There was a 64% response rate. Responders were more likely to be from larger practices, in less deprived areas, and with lower prescribing costs than were non-responders. Multivariable analysis showed that GPs with high prescribing costs were significantly more likely to work in dispensing practices, in practices with low income populations, in single handed practices, and in practices without a GP trainer. They were also significantly more likely to see drug company representatives more frequently, to prescribe newly available drugs more freely, to prescribe more readily to patients who expect a prescription, to report high levels of frustration from lack of time in the consultation, to find unsatisfactory those consultations which ended in advice only, and to express dissatisfaction with their review methods for repeat prescribing. They were significantly less likely to find useful criticism of prescribing habits by colleagues, and to check the BNF rather than other sources when uncertain about an aspect of drug treatment.

CONCLUSIONS: While they cannot be held to have a causal relationship, the pattern of attitudes towards prescribing of GPs in the highest quintile of prescribing costs provide the basis for developing an educational intervention which may be an acceptable method of modifying the attitudes of GPs and consequently reducing their prescribing costs.

Keywords:
MeSH Terms: Attitude of Health Personnel* Cross-Sectional Studies Drug Utilization/economics* Female Germany Great Britain Health Care Surveys Health Expenditures Humans Male Physician's Practice Patterns/economics* Physician's Practice Patterns/statistics & numerical data Physicians, Family/psychology* Prescriptions, Drug/economics* Prescriptions, Drug/statistics & numerical data Questionnaires Research Support, Non-U.S. Gov't State Medicine/economics

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909