Evaluating Physicians’ Perception Of Limitations And Obstacles Against The Effectiveness Of “Audit And Feedback” And “Printed Educational Materials” Interventions On Prescribing Behavior: A Qualitative Study

Abstract

Different interventions including “audit and feedback” (A&F) and “printed educational materials” (PEM) are being employed both in Iran and the world in general to improve physicians’ prescribing behavior. While several interventional studies have assessed effectiveness of these interventions, only few studies have investigated the views of physicians and other stakeholders about these interventions. The purpose of this study was to evaluate prescribers’ views about the limitations and obstacles of using A&F and PEM interventions effectively. The current qualitative study was performed using a semi-structured one to one and group interviews in the 2013-2014 period. 18 general practitioners, pediatricians and infection specialists from Tehran and Yazd were interviewed and twelve physicians and pharmacists attended the focus group discussion meeting. The interviews and the meeting were recorded, transcribed and encoded. For analysis of the content, the framework method was employed. The resulting data in this study include six themes and 25 sub-themes. Awareness of the behavior-changing intervention, the effect of intervention in changing the behavior, A&F format and content, the underlying factors affecting drug prescribing behavior, the way PEM are delivered, and preferred intervention in promoting rational drug prescribing are the themes derived from this study. The study demonstrated limited awareness of different interventions for improving prescribing behavior. Moreover, the doctors suggested different modifications in the format and delivery of feedbacks and PEMs. They also noted the multi-dimensionality of prescribing behavior, and hence highlighting the need to attend other concerns such as patients’ expectations, the perceived low quality of generic medicines in Iran, and the presence of financial issues between doctors and patients. Improving the effectiveness of such interventions requires careful attention to the interrelationships between doctors, pharmacists and patients.