Trial reportBMJ (Clinical research ed.)2004
Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study.
Trial report in BMJ (Clinical research ed.), 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 148 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
148 citing papers in PubMed, 3 syntheses or guidelines pooled it, 331 citations in OpenAlex.
- The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis.BMC musculoskeletal disorders · 2021Pooled it
- Factors Influencing Prescribing Decisions of Physicians: A Review.Ethiopian journal of health sciences · 2018Pooled it
- Content and outcome of usual primary care for back pain: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2008Pooled it
- Standardized Patient Communication and Low-Value Spinal Imaging: A Randomized Clinical Trial.JAMA network open · 2024Trial
- Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021Trial
- Reducing antibiotic prescriptions for respiratory tract infections in family practice: results of a cluster randomized controlled trial evaluating a multifaceted peer-group-based intervention.NPJ primary care respiratory medicine · 2016Trial
- Process evaluation of a point-of-care cluster randomised trial using a computer-delivered intervention to reduce antibiotic prescribing in primary care.BMC health services research · 2014Trial
- Converting habits of antibiotic prescribing for respiratory tract infections in German primary care--the cluster-randomized controlled CHANGE-2 trial.BMC family practice · 2012Trial
- Trial
- Knowledge of the pharmacological profile of a patient improves the quality of prescribing, the outcomes of treatment, and the utilization of health services in primary health care.European journal of clinical pharmacology · 2011Trial
- Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial.BMJ (Clinical research ed.) · 2009Trial
- Improving management of patients with acute cough by C-reactive protein point of care testing and communication training (IMPAC3T): study protocol of a cluster randomised controlled trial.BMC family practice · 2007Trial
- Randomised controlled trial of effect of leaflets to empower patients in consultations in primary care.BMJ (Clinical research ed.) · 2004Trial
- Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial.Annals of family medicineTrial
- Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial.Annals of family medicineTrial
- A Brief Shared Decision-Making Intervention for Acute Respiratory Infections on Antibiotic Dispensing Rates in Primary Care: A Cluster Randomized Trial.Annals of family medicineTrial
- Health care utilization up to 11 years after diagnosis among patients with a hematologic malignancy and its association with socioeconomic position.Journal of cancer survivorship : research and practice · 2026Article
- Additional Investigations and Referrals by Primary Care Physicians in Uncertain Clinical Situations: Cross-Sectional Study Using Virtual Patient-Based Scenarios.JMIR formative research · 2026Article
- Healthcare inequalities in general practice due to educational level: A retrospective cohort study analysing patients' presentation and GP response to requests.The European journal of general practice · 2026Article
- Prevalence and patterns of antibiotic prescriptions in Conakry hospitals, Guinea: a multicentre cross-sectional survey.JAC-antimicrobial resistance · 2025Article
88 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess how pressures from patients on doctors in the consultation contribute to referral and investigation.
designObservational study nested within a randomised controlled trial.
settingFive general practices in three settings in the United Kingdom.
participants847 consecutive patients, aged 16-80 years. MAIN OUTCOMES MEASURES: Patient preferences and doctors' perception of patient pressure and medical need.
resultsPerceived medical need was the strongest independent predictor of all behaviours and confounded all other predictors. The doctors thought, however, there was no or only a slight indication for medical need among a significant minority of those who were examined (89/580, 15%), received a prescription (74/394, 19%), or were referred (27/125, 22%) and almost half of those investigated (99/216, 46%). After controlling for patient preference, medical need, and clustering by doctor, doctors' perceptions of patient pressure were strongly associated with prescribing (adjusted odds ratio 2.87, 95% confidence interval 1.16 to 7.08) and even more strongly associated with examination (4.38, 1.24 to 15.5), referral (10.72, 2.08 to 55.3), and investigation (3.18, 1.31 to 7.70). In all cases, doctors' perception of patient pressure was a stronger predictor than patients' preferences. Controlling for randomisation group, mean consultation time, or patient variables did not alter estimates or inferences.
conclusionsDoctors' behaviour in the consultation is most strongly associated with perceived medical need of the patient, which strongly confounds other predictors. However, a significant minority of examining, prescribing, and referral, and almost half of investigations, are still thought by the doctor to be slightly needed or not needed at all, and perceived patient pressure is a strong independent predictor of all doctor behaviours. To limit unnecessary resource use and iatrogenesis, when management decisions are not thought to be medically needed, doctors need to directly ask patients about their expectations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.