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Identifier

000375519

Title

Μελέτη παραγόντων που επηρεάζουν την συνταγογραφική συμπεριφορά των γενικών ιατρών σε ιατρεία πρωτοβάθμιας φροντίδας υγείας του νομού Ηρακλείου

Alternative Title

Factors tha influence general practitioners' medication prescribing behavior in primary care practices in Heraklion prefecture, Crete, Greece

Author

Δημητρακόπουλος, Στυλιανός

Thesis advisor

Λιονής, Χρήστος

Reviewer

Faresjo, Tomas

Abstract

INTRODUCTION: Polypharmacy and irrational medication prescribing is a major public health problem and one of the main causes of healthcare waste resources. General practitioners medication prescriptions represent a significant percentage of the total medication cost and this is mainly because of the general aspect of the specialty . Several factors related either to patients' or doctors' characteristics have been reported to influence prescription patterns. Such factors are patients or their relatives requests for drugs, many of which have been precedently supplied by their pharmacist without a prescription and the influence exerted by pharmaceutical industries sales representatives. Polypharmacy remains an unresolved problem despite the efforts that governments have taken so far. Therefore, it is necessary to further evaluate the factors which influence medication prescription and identify those that can be modified, with the aim to design effective interventions towards rational prescribing. A European project with the running title « Assessing The Over-The-Counter Medications In Primary Care And Translating The Theory Of Planned Behaviour Into Interventions» has been approved by the European Committee. The present study was developed in the context of that project. AIM: To investigate factors that influence GPs' intention to prescribe. OBJECTIVES: To evaluate the impact on GPs' intention to prescribe of factors as: Α) Pressure exerted from patient’s representatives (relatives, friends, neighbors) to get a prescription Β) Pharmaceutical industries sales representatives C) Colleagues D) Social and demographic characteristics E) Patient’s request for prescribing medicines that have already been obtained from the pharmacy METHODS: Qualitative research methods were used. Face to face interviews with GPs with the use of specific questionnaires were performed. Interviews were conducted during the first two weeks of August 2011 in health care centers and practices in the prefecture of Heraklion. For the purpose of the present study parts of questionnaires that have been already used in the previous mentioned multicenter European study -designed according to the Theory of Planned Behavior- , were used. These questionnaires included information on social-demographic features, as well as qualitative questions using Likert scales. Items of the questionnaire that were related to the research questions were isolated and grouped. Questions that had the best internal consistency (Cronbach’s α index) were selected and the average score of answers was calculated. Logistic regression analysis was used in order to estimate the correlation between prescribing intention and research questions. RESULTS: 59 out of 100 general practitioners of the prefecture of Heraklion accepted to participate in the present study. 36/59 (61%) were males and 23/59 (39%) females. Their median age was 43 years. 43 ( 73%) worked in a rural area, 9 (15%) in a semi urban and 7 (12%) in a urban area. 13 (22%) of them had master degree or a PHD. GP’s intention to prescribe was not influenced either by patient’s representatives (relatives, friends, neighbors) request for prescription or by patients’ demands for prescribing drugs that have already been supplied. Factors that have been shown to play a significant role in the intention for prescribing were: doctors’ relations with pharmaceutical companies, other colleagues’ influence and the patients’ low educational level. GPs who approved relationships with drug companies had 3,2 times stronger intention to prescribe compared with those that didn't. Furthermore, GPs who considered important other colleagues’ opinion had 5 times greater possibility to prescribe compared with those who were not influenced by their colleagues’ opinion. Finally, intention for prescribing was 4,6 times stronger in GPs who admitted that they feel pressure from patients with low educational level. GPs who had a positive attitude towards relations with pharmaceutical industry prescribed medication more easily in patients with low educational level. CONCLUSIONS: GPs are more willing to prescribe when they approve the relations with the pharmaceutical companies and accept their special offers. They also prescribe more easily in patients with low educational level and when they are influenced by other colleagues. GPs are not influenced by patients’ demand for prescribing drugs that have already been supplied or from patients’ request for prescribing through a third person. The Theory of Planned Behavior has many applications in designing policies to alter patients and doctors’ attitudes regarding the medication use and prescription. Identifying some of the most important factors of the doctors’ behavior towards prescribing, by using the theory of planned behavior permits the formulation of behavioral interventions as well as the identification of their ability to change the attitudes and beliefs of doctors regarding medication prescribing.

Language

Greek

Subject

Drug Prescriptions

Drug Therapy

General practitioner

Medication prescription

Pharmaceutical companies

Pharmaceutical industry

Pharmaceutical sales representatives

Polypharmacy

Prescribing patterns