ArticleQuality & safety in health care2002
Scope and nature of prescribing decisions made by general practitioners.
Article in Quality & safety in health care, 2002. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Context and general practitioner decision-making - a scoping review of contextual influence on antibiotic prescribing.BMC family practice · 2021Article
- Integrating Xpert MTB/RIF for TB diagnosis in the private sector: evidence from large-scale pilots in Patna and Mumbai, India.BMC infectious diseases · 2021Article
- Prescribing Behavior of General Practitioners for Generic Drugs.International journal of environmental research and public health · 2020Article
- Naturalistic Decision Making in After-Action Review Meetings: The Implementation of and Learning from Post-Fall Huddles.Journal of occupational and organizational psychology · 2015Article
- Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment: a qualitative study among primary care physicians in Sweden.Scandinavian journal of primary health care · 2013Article
- What are the perceived learning needs of Australian general practice registrars for quality prescribing?BMC medical education · 2010Article
- Evaluating the clinical appropriateness of nurses' prescribing practice: method development and findings from an expert panel analysis.Quality & safety in health care · 2007Article
- Limited effect of patient and disease characteristics on compliance with hospital antimicrobial guidelines.European journal of clinical pharmacology · 2006Article
- Prescribing errors and other problems reported by community pharmacists.Therapeutics and clinical risk management · 2005Article
- Adherence barriers to antimicrobial treatment guidelines in teaching hospital, the Netherlands.Emerging infectious diseases · 2004Article
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThis study describes cognitive processes of doctors who are deciding on the treatment for a patient. This helps to uncover how prescribing decisions could benefit from (computerised) support.
methodsWhile thinking aloud, 61 general practitioners made prescribing decisions for five patients with urinary tract infections or stomach complaints. The resulting 305 transcripts were analysed to determine the scope and nature of the decision processes. Differences in the process were related to case or doctor characteristics, and to differences in the quality of prescribing behaviour.
resultsThe decision processes were not extensive, particularly for patients with a urinary tract infection. The doctors did not actively consider all possible relevant information. Considerations referring to core aspects of the treatment were made in 159 cases (52%) and to contextual aspects in 111 cases (36%). Habitual behaviour, defined as making a treatment decision without any specific contemplation, was observed in 118 cases (40%) and resulted in prescribing first choice as well as second choice drugs. For stomach complaints, second choice drugs were often prescribed after considering other treatments or in view of specific circumstances. Experience of the doctor was not related to the type of decision process.
conclusionsThe processes observed deviate from the decision theoretic norm of thoroughly evaluating all possible options, but these deviations do not always result in suboptimal prescribing. Decision support is useful for bringing pertinent information and first choice treatments to the prescriber's attention. In particular, information about relevant contraindications, interactions, and costs could improve the quality of prescribing.
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