Introduction

Recent initiatives from the Department of Health describe the Government's drive for quality, effectiveness and efficiency in all areas of the NHS, including prescribing^1,2,3. The newly formed Primary Care Trusts (PCTs) are responsible for implementing national quality measures into local practice. As well as local priorities such as HiMPs and HAZs, the PCTs develop their own monitoring programmes and quality measures as well as educational outreach to general practitioners (GPs) based on national frameworks. The aim of this study is to evaluate the development and implementation of formularies in two PCTs, and the factors influencing prescribing in both PCTs. The study comprises an exploratory phase (described here) and these findings will be used to develop outreach programmes to implement formularies in two different settings.

Aims

This phase of the study aims to explore the factors influencing GPs prescribing as perceived by GPs themselves. The abstract describes preliminary data; final results will be discussed at the conference.

Methods

A questionnaire was designed to explore the factors GPs identified as having an influence on their prescribing. This was sent to all GPs (N=228) in two East London PCTs. The questionnaire comprised two sections; the factors perceived to influence prescribing and attitudes towards the local drug guidelines. Responses were recorded on dichotomous (Yes/No) and 5-step Likert scales (Strongly Agree- Strongly Disagree). The data were entered into a database and analysed quantitatively with SPSS Version 10.0.

Results

At the time of submission, there was a 61% response rate and questionnaires were still being collected. Over half (60%) of the GPs identified that patient expectations influenced them, even more so when the patient had been prescribed the drug previously. Over half the GPs (63%) considered prescription charges to the patient when issuing a prescription. Perhaps not surprisingly, "specialists" had a great effect on GPs prescribing (92%), whereas there was varying dependence on Internet information (only 14% agreement); and advertisements in journals (8%) compared to articles in journals (87%). Only 10% of the population felt that drug representatives had any influence, although one quarter of the GPs were visited by them regularly. Local prescribing guidelines were felt to be as much of an influence as national guidelines (90% agreement); over half the sample felt local guidelines were necessary for good prescribing (58%) and cost effective prescribing (71%). However, only one third (37%) of the GPs admitted using the local guidelines more than once a month.

Discussion

It seems from preliminary analysis that factors influencing prescribing include specialists and peer discussion, the patient's expectations and previous prescribing and local or national guidelines. Further findings will be presented at the conference. How these factors relate and influence prescribing will be further explored in one-to-one interviews with GPs which, together with results from the questionnaire will help to develop outreach programmes for GPs (to be undertaken by PCT pharmacists) in the two PCTs: the intervention. The more we know about what influences prescribing, the better we can design steering interventions to make sure drugs are being prescribed wisely and cost effectively.

References

1. A First Class Service. Quality in the new NHS. NHS White Paper. NHS Executive Publication. 1998.

2. Pharmacy in the Future � Implementing the NHS plan. Department of Health. September 2000.

3. Shifting the Balance of Power within the NHS. Department of Health. July 2001.