ABSTRACT
BACKGROUND: Registration studies have shown great variations in prescribing volume and prescribing patterns of benzodiazepines (BZDs) and minor opiates among GPs. OBJECTIVES: We aimed to form a basis for hypotheses and build theories about prescribing, in order to investigate how high-prescribing doctors can legitimize their own prescribing pattern. METHODS: A qualitative interview study of doctors with previously known high, medium and low prescribing volumes was performed. The interpretation focused on the doctors' self-explanations and how they influence their daily decision of prescribing. RESULTS AND CONCLUSIONS: It was a striking feature that many of the attitudes towards the drugs were common both within and between the three groups of prescribers. All doctors regarded the task of prescribing as difficult, and the great majority strongly advocated restriction in prescribing. In order to cope with daily practice and to live with high prescribing volumes, doctors make use of effective working strategies. These strategies, of ascribing responsibility to the previous doctor, to patient autonomy and responsibility, to the patient's age and to concomitant diseases, are described in this study. An allocation of responsibility to other persons or circumstances delimits the doctors' professional discretion in this matter. Striking differences between prescriber groups were not found in the analysis, but when all small tendencies in all steps of the decision-making process were added, a clear trend was revealed.
Subject(s)
Analgesics, Opioid/therapeutic use , Anti-Anxiety Agents/therapeutic use , Benzodiazepines/therapeutic use , Narcotics/therapeutic use , Practice Patterns, Physicians' , Adult , Cross-Sectional Studies , Ethics, Medical , Family Practice , Health Care Surveys , Humans , Middle Aged , Norway , Physician-Patient Relations , Social ResponsibilityABSTRACT
In two Norwegian counties all prescriptions for benzodiazepines and analgesics containing codeine were registered over a two month period and the records were subsequently transferred to a database. 93,000 prescriptions were registered, equivalent to this 2.8 millions DDD. The registration showed great variation, both in the doctors' volume of prescribing and their prescribing patterns. 30 doctors of the total of 4,000 were responsible for 13% of the total volume prescribed. We propose that the doctors with unacceptable prescribing rates should be offered a special education program provided by the Norwegian Medical Association. The computer routines of the pharmacies appear to be inadequate for registration and research purposes. In 2% of all the prescriptions the doctors name could not be identified. Thus it seems warranted to use the doctors' identity number on prescriptions for these drugs. A reduction of the number of tablets in the largest packages dispensed should be considered by the authorities. For effective quality control of prescribing, better understanding is needed of the differences in doctors' prescribing patterns.
