What are the perceived learning needs of Australian general practice registrars for quality prescribing?

Rola Ajjawi,Jill E Thistlethwaite,Parisa Aslani,Nick B Cooling

doi:10.1186/1472-6920-10-92

Abstract

BackgroundLittle is known about the perceived learning needs of Australian general practice (GP) registrars in relation to the quality use of medicines (QUM) or the difficulties experienced when learning to prescribe. This study aimed to address this gap.MethodsGP registrars' perceived learning needs were investigated through an online national survey, interviews and focus groups. Medical educators' perceptions were canvassed in semi-structured interviews in order to gain a broader perspective of the registrars' needs. Qualitative data analysis was informed by a systematic framework method involving a number of stages. Survey data were analysed descriptively.ResultsThe two most commonly attended QUM educational activities took place in the workplace and through regional training providers. Outside of these structured educational activities, registrars learned to prescribe mainly through social and situated means. Difficulties encountered by GP registrars included the transition from hospital prescribing to prescribing in the GP context, judging how well they were prescribing and identifying appropriate and efficient sources of information at the point of care.ConclusionsGP registrars learn to prescribe primarily and opportunistically in the workplace. Despite many resources being expended on the provision of guidelines, decision-support systems and training, GP registrars expressed difficulties related to QUM. Ways of easing the transition into GP and of managing the information 'overload' related to medicines (and prescribing) in an evidence-guided, efficient and timely manner are needed. GP registrars should be provided with explicit feedback about the process and outcomes of prescribing decisions, including the use of audits, in order to improve their ability to judge their own prescribing.

Highlights

Little is known about the perceived learning needs of Australian general practice (GP) registrars in relation to the quality use of medicines (QUM) or the difficulties experienced when learning to prescribe
A small proportion of adverse outcomes are severe and safety nets are less available in some settings such as general practice (GP)
We developed an online questionnaire to explore the uptake of QUM programs related to prescribing by GP registrars based on questions identified in the literature, our experience with the target population and our research questions

Summary

Introduction

Little is known about the perceived learning needs of Australian general practice (GP) registrars in relation to the quality use of medicines (QUM) or the difficulties experienced when learning to prescribe. The practice of quality use of medicines (QUM) aims to reduce prescribing errors and possible adverse effects in patients. Prescribing errors in clinical practice are common, accounting for around 2-14% (median rate 7%) of prescriptions or medication orders in most studies. While prescribing errors are common, they may not result in actual adverse outcomes for the patient. Most prescribing errors are minor, and are detected by pharmacists or nurses, especially in the hospital setting, preventing patient harm [3,13,14]. A small proportion of adverse outcomes are severe and safety nets are less available in some settings such as general practice (GP)

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