Introduction/background

Appropriate medication can improve functioning and quality of life. Medication strategies include new approaches to old medications, and use of new, more expensive medications with improved side-effect and efficacy profiles. An example of the latter is the new 'atypical' antipsychotic drugs for the treatment of schizophrenia. The prescribing of these medications has been a controversial issue for the past few years due to cost, rationing procedures, lack of evidence to support their use, the side-effect profiles and the lack of clear guidelines and protocols. The National Institute for Clinical Excellence is planning to produce clinical guidelines for early onset schizophrenia in mid-2002. The benefits of the atypical antipsychotic drugs means more patients with schizophrenia are being managed in the community. This has resulted in increased contact with the General Practitioner (GP) and the prescribing costs being transferred from secondary to primary care. GPs will increasingly need to be clear about their rights and duties in respect to their patients.

Aim

To examine the prescribing responsibilities of GPs in the management of schizophrenia and, specifically, their views of 'atypical' antipsychotic drugs.

Methods

This was a qualitative study using semi-structured interviews with 19 GPs (13 male, 6 female). Interviews were carried out between November 2000 and June 2001. All interviews were audio-taped and transcribed. Thematic analysis was used to identify patterns of experiences and views between the GPs.

Results and discussion

The level of involvement that the GPs have in prescribing for patients with schizophrenia is influenced by their knowledge, experience and the nature and type of communication they have with psychiatrists.

The GPs involvement in the initiation of medication was mainly for conventional antipsychotics to stabilise the patient while waiting for a psychiatrist opinion. The major role for GPs was that of continuing medication. Most GPs took a passive role and accepted all treatment decisions initiated in secondary care. Only one GP felt able to question the psychiatrist's prescribing advice A minority were comfortable altering doses independently. Few GPs would change a medication once it had been initiated, Some GPs contrasted schizophrenia to other conditions, even within mental health, in which they were confident in making all clinical decisions.

GPs were very aware of the cost implications associated with the atypical antipsychotic drugs. However, a number of GPs felt they could justify the expenditure for these drugs by considering the wider economic implications beyond the budgetary constraints, such as getting people back into work.

Conclusion

Although GPs were managing patients with schizophrenia in primary care and with that taking on the responsibility for prescribing the atypical antipsychotic drugs, few GPs felt they had either the experience or knowledge to take over the full responsibility for prescribing. Many GPs regarded the psychiatrist as their source of information for these drugs however, with the changing pace of mental health services and lack of support in many areas GPs felt they need more information before prescribing and were happy to remain providing general management than prescribing specifically.