Secondary care doctors' perception of appropriate prescribing

Abstract

As the prescribing of drugs in secondary care is known to influence prescribing in primary care and because an understanding of prescribers' reasoning is essential for evaluating prescribing appropriateness, the aim of this study was to investigate secondary care doctors' views of appropriate prescribing, using qualitative individual interviews. Qualitative, semi-structured individual interviews were conducted with 15 hospital doctors working in different medical specialities. The interviews, covering the doctors' views of the meaning of 'appropriate' prescribing, were audiotaped and analysed from an interpretivist perspective. Three different main themes were identified in the analysis of how the doctors perceived appropriate prescribing: 'individualization of treatment', 'cost' and 'time'. Most importantly, treatment should be adjusted to the individual patient, although cost should also be justified. Ongoing medication reviews should be carried out, to adjust to changes in patient-related factors over time. The hospital doctors brought up continuous review as a necessary part of appropriate prescribing. Thus, from the prescribers' point of view, this time perspective should be explicitly incorporated in definitions of appropriate prescribing, in addition to individualization of treatment and cost considerations.