General practitioners' views on the appropriateness of their long-term prescribing

Abstract

Objective: To identify cases of potentially inappropriate long-term prescribing, explore GPs views of the findings and identify common themes which may underlie inappropriate prescribing. Methods: A previously validated set of indicators was applied to the records of 101 patients in ten general practices. Subsequently, semi-structured interviews were conducted with 22 GPs. The interviews discussed 227 instances of prescribing, identified as ‘potentially inappropriate’, for the 101 patients. A coding frame for analysis was developed and applied systematically to the interview data. The inter-rater reliability of the coding frame was assessed. Results: In 98 (43%) instances the GP either gave unqualified agreement that the prescribing was inappropriate or indicated that the patient should be reviewed. In a further 76 (33%) cases, the GP agreed that prescribing looked inappropriate but volunteered external factors perceived to influence drug usage. The most frequently cited influence was hospital-led prescribing, followed by historical prescribing and patient pressure. In 33 (15%) cases, the GP either did not feel that the issue identified was of clinical importance or felt that their decision to prescribe was appropriate. In 20 (9%) cases the GPs explained their decisions by describing factors which were known to them, but not documented in the patient record. Assessment of inter-rater agreement demonstrated reliability. Conclusions: Application of validated prescribing indicators identified cases where GPs agreed that their prescribing for individual patients was inappropriate. The interviews revealed three clear factors that may go some way towards explaining apparently inappropriate prescribing and be used to form strategies to improve the quality of long-term prescribing in general practice. Eur J Gen Pract 2000;6:5–9.