• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. Feb 2003; 53(487): 120–125.
PMCID: PMC1314511

A qualitative study to explore influences on general practitioners' decisions to prescribe new drugs.


BACKGROUND: Ensuring appropriate prescribing is an important challenge for the health service, and the need for research that takes account of the reasons behind individual general practitioners' (GPs) prescribing decisions has been highlighted. AIM: To explore differences among GPs in their decisions to prescribe new drugs. DESIGN OF STUDY: Qualitative approach, using in-depth semistructured interviews. SETTING: Northern and Yorkshire Health Authority Region. METHOD: Participants were identified from a random sample of 520 GPs in a quantitative study of patterns of uptake of eight recently introduced drugs. Purposeful sampling ensured inclusion of GPs prescribing any of the eight drugs and working in a range of practice settings. Fifty-six GPs were interviewed, using a topic guide. Interviews were recorded on audiotape. Transcribed text was methodically coded and data were analysed by constantly comparing emerging themes. RESULTS: Both low and high prescribers shared a view of themselves as conservative in their prescribing behaviour. Low prescribers appeared to conform more strongly to group norms and identified a consensus among practice partners in prescribing and cost-consciousness. Conformism to group norms was represented by a commitment to practice formularies. High prescribers more often expressed themselves to be indifferent to drug costs and a shared practice ethos. CONCLUSIONS: A shift in the attitudes of some GPs is required before cost-effectiveness is routinely incorporated in drug prescribing. The promotion of rational prescribing is likely to be more successful if efforts are focused on GPs' appreciation of cost issues and attitudes towards shared decision-making and responsibility.

Full Text

The Full Text of this article is available as a PDF (81K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bradley CP. Uncomfortable prescribing decisions: a critical incident study. BMJ. 1992 Feb 1;304(6822):294–296. [PMC free article] [PubMed]
  • Allery LA, Owen PA, Robling MR. Why general practitioners and consultants change their clinical practice: a critical incident study. BMJ. 1997 Mar 22;314(7084):870–874. [PMC free article] [PubMed]
  • Segal R, Hepler CD. Drug choice as a problem-solving process. Med Care. 1985 Aug;23(8):967–976. [PubMed]
  • Soumerai SB, Avorn J. Predictors of physician prescribing change in an educational experiment to improve medication use. Med Care. 1987 Mar;25(3):210–221. [PubMed]
  • Schwartz RK, Soumerai SB, Avorn J. Physician motivations for nonscientific drug prescribing. Soc Sci Med. 1989;28(6):577–582. [PubMed]
  • Isacsson G, Redfors I, Wasserman D, Bergman U. Choice of antidepressants: questionnaire survey of psychiatrists and general practitioners in two areas of Sweden. BMJ. 1994 Dec 10;309(6968):1546–1549. [PMC free article] [PubMed]
  • Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations--a questionnaire study. BMJ. 1997 Aug 30;315(7107):520–523. [PMC free article] [PubMed]
  • Barber N. What constitutes good prescribing? BMJ. 1995 Apr 8;310(6984):923–925. [PMC free article] [PubMed]
  • Armstrong D, Reyburn H, Jones R. A study of general practitioners' reasons for changing their prescribing behaviour. BMJ. 1996 Apr 13;312(7036):949–952. [PMC free article] [PubMed]
  • Taylor RJ, Bond CM. Change in the established prescribing habits of general practitioners: an analysis of initial prescriptions in general practice. Br J Gen Pract. 1991 Jun;41(347):244–248. [PMC free article] [PubMed]
  • McGavock H, Webb CH, Johnston GD, Milligan E. Market penetration of new drugs in one United Kingdom region: implications for general practitioners and administrators. BMJ. 1993 Oct 30;307(6912):1118–1120. [PMC free article] [PubMed]
  • Avery AJ, Heron T, Lloyd D, Harris CM, Roberts D. Investigating relationships between a range of potential indicators of general practice prescribing: an observational study. J Clin Pharm Ther. 1998 Dec;23(6):441–450. [PubMed]
  • Avery AJ, Rodgers S, Heron T, Crombie R, Whynes D, Pringle M, Baines D, Petchey R. A prescription for improvement? An observational study to identify how general practices vary in their growth in prescribing costs. BMJ. 2000 Jul 29;321(7256):276–281. [PMC free article] [PubMed]
  • Mapes RE. Physicians' drug innovation and relinquishment. Soc Sci Med. 1977 Sep;11(11-13):619–624. [PubMed]
  • Pope C, Mays N. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ. 1995 Jul 1;311(6996):42–45. [PMC free article] [PubMed]
  • Grant James A, Dowell Jon. A qualitative study of why general practitioners admit to community hospitals. Br J Gen Pract. 2002 Aug;52(481):628–635. [PMC free article] [PubMed]
  • Denig P, Haaijer-Ruskamp FM, Zijsling DH. How physicians choose drugs. Soc Sci Med. 1988;27(12):1381–1386. [PubMed]
  • Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations--a questionnaire study. BMJ. 1997 Aug 30;315(7107):520–523. [PMC free article] [PubMed]
  • Marshall Martin, Sheaff Rod, Rogers Anne, Campbell Stephen, Halliwell Shirley, Pickard Susan, Sibbald Bonnie, Roland Martin. A qualitative study of the cultural changes in primary care organisations needed to implement clinical governance. Br J Gen Pract. 2002 Aug;52(481):641–645. [PMC free article] [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...