Prescribing & Medicines Management
Issue no 1, p4
January/February 2003

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Individual patients influence doctors’ views of appropriate prescribing

Doctors view appropriate and inappropriate prescribing in terms of individual patients and drugs rather than at a more general public health level, new research suggests.

The analysis of recorded interviews with 32 doctors about what they understood by appropriate and inappropriate prescribing found that it was often easier for doctors to define inappropriate prescribing than appropriate prescribing.

Most cited prescribing without a clear diagnosis or where there were contraindications as examples of inappropriate prescribing, but few doctors mentioned the need to document the indication for which they were prescribing as examples of appropriate prescribing practice, the study found.

Financial costs were mentioned as a factor in decisions about whether prescribing was appropriate or inappropriate, but only as a last resort, say the authors. The only sub-group of doctors that saw prescribing in rigid terms was junior house officers, who saw appropriateness as relating to clinical guidelines and the use of formularies.

The authors, from the School of Pharmacy and Pharmaceutical Sciences, University of Manchester, call for assessments of prescribing quality to recognise the complexity of prescribing decisions that doctors deem appropriate if they are to be accepted by the prescribers (Journal of Social and Administrative Pharmacy 2002; 19(6): 223).