Abstract
BackgroundCare goals are often implicit, although their identification is a key element of any prescription process. This study aimed to describe the clinical goals of drug prescriptions in general practice, their determinants and the agreement between physicians and patients.MethodsThis was a cross-sectional study conducted by 11 resident trainees acting as observers in 23 general practices. The residents recorded the indication and main physician’s goal for all drugs prescribed during five consultation days in each practice in December 2015, and the main patient’s goal for a sub-sample of consultations. We used an eight-category generic classification of prescription goals, including three specific (mortality, morbidity and cure), three non-specific (symptoms, quality of life, functioning) and two non-specified (other goal, no goal) categories. Analyses were based on a multivariable, multilevel model and on the kappa statistic applied to the sub-sample of consultations.ResultsThe sample encompassed 2141 consultations and 5036 drugs. The main physicians’ goal of drug prescriptions was to relieve symptoms (43.3%). The other goals were to decrease the risk of morbidity (22.4%), to cure disease (11.7%), to improve quality of life (10.6%), to decrease the risk of mortality (8.5%) and to improve functioning (1.8%). The choice of a specific goal was more frequent in patients with the following characteristics: over 50 (OR [1.09;1.15]), of male gender (OR [1.09;1.39]), with full financial coverage for a long-term condition (OR [1.47;1.97]), known by the physician (OR [1.19;2.23]), or with a somatic health problem (OR [2.56;4.17]). Cohen’s kappa for drug prescription goals between the patients and the physicians was 0.26 (0.23–0.30).ConclusionsPhysicians’ goals are poorly shared with patients. It remains to be assessed whether it is possible to collect and discuss information on prescription goals on a daily basis.
Highlights
Care goals are often implicit, their identification is a key element of any prescription process
Distribution of prescription goals The main goal of drug prescription by the physicians was to relieve symptoms (43.3%) before decreasing the risk of morbidity (22.4%), curing or providing remission of disease (11.7%), improving quality of life (10.6%), decreasing the risk of mortality (8.5%) and improving functioning (1.8%)
To the best of our knowledge, this study is the first attempt to describe the clinical goals of drug prescription in an unselected sample of patients attending general practice
Summary
Care goals are often implicit, their identification is a key element of any prescription process. The medical process usually starts with the identification of a health problem and the determination of a diagnosis It is only after those steps, and according to the diagnosis that has been established, that a therapeutic decision is made. This decision, which aims to have a positive effect on the health of the patient, requires setting one or several care goals that can be somehow formalized. The identification of these goals is acknowledged to be one of the key elements of any prescription process [1]. A clinical approach that includes explicit goals, measurable at the patient level, allows for the possibility to use them for monitoring treatment and for assessing care quality in terms of results [8, 9, 16, 17]
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