Prescribing Information Resources: Use and preference by general practitioners An exploratory survey of general practitioners Report to the Ministry of Health



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Prescribing Information Resources:


Use and preference by general practitioners

An exploratory survey of general practitioners



Report to the Ministry of Health

by

The Centre for Health Services Research and Policy

and

Department of General Practice and Primary Health Care

The University of Auckland


December 2005

Research Team

Bruce Arroll, Felicity Goodyear-Smith, Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland

Daniel Patrick, Centre for Health Services Research and Policy (CHSRP), School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland

Ngaire Kerse, Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland

Jeff Harrison, School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland

Joan Halliwell, Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland

Janet Pearson, Roy Lay-Yee and Martin von Randow, Centre for Health Services Research and Policy (CHSRP), School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland and Department of Sociology, Faculty of Arts, The University of Auckland

with the assistance of Carol Ramage, Centre for Health Services Research and Policy (CHSRP), School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland

and with the support of The Survey Research Unit (SRU).


Inquiries Contact


Centre for Health Services Research and Policy

The University of Auckland

Private Bag 92019

Auckland


Ph: 09 373 7599

Email: chsrp@auckland.ac.nz

Citation: Arroll B, Goodyear-Smith F, Patrick D, Kerse N, Harrison J, Halliwell J, Pearson J,
Lay-Yee R, von Randow M. 2005. Prescribing Information Resources: Use and preference
by general practitioners: An exploratory survey of general practitioners:
Report to the Ministry of Health, July 2005.
Wellington: Ministry of Health.

Published in December 2005 by the Ministry of Health, PO Box 5013, Wellington, New Zealand

ISBN 0-478-29644-4 (Web)
HP 4160

This document is available on the Ministry of Health’s website: http://www.moh.govt.nz



Disclaimer


The views expressed in this occasional paper are the personal views of the authors and should not be taken to represent the views or policy of the Ministry of Health or the Government. Although all reasonable steps have been taken to ensure the accuracy of the information, no responsibility is accepted for the reliance by any person on any information contained in this occasional paper, nor for any error in or omission from the occasional paper.

Acknowledgements

The study team would like to express their gratitude to the general practitioners who took part in this survey; and additionally, appreciation to the interviewers for their work and efforts to complete this survey.
The Ministry of Health funded this project.
We also thank our reviewers for their comments: Robert Phillips, David Woods, Jim Primrose, Stephen Lungley, Rachel Mackay, Sharon Woollaston. Responsibility for the final product, however, rests ultimately with the authors.


Contents


Research Team ii

Inquiries Contact ii

Disclaimer iii

Acknowledgements iii

Contents iv

Executive Summary viii

Introduction viii

Methods viii

Results viii

Information resources ix

Influences on prescribing ix

Conclusions and implications x

1 Introduction 1

1.1 Background to the project 1

1.2 Aims and research questions 2

1.3 Literature review 2

1.4 Possible strategies suggested by the literature to encourage evidence-based prescribing 5

1.5 This report 6

2 Methodology 9

2.1 Organisation 9

2.2 Information collection – questionnaire design 9

2.3 Sampling 10

2.4 Recruitment and data collection processes 10

2.5 Computer assisted telephone interviewing (CATI) 11

2.6 Data 11

2.7 Ethical issues 12

3 Results 13

3.1 Participant characteristics 13

3.2 Primary prescribing resources 14

3.3 Frequency of use and value of standard prescribing resources 16

3.4 Frequency of use and value of medical journals for prescribing information 18

3.5 Use of internet resources 20

3.6 Medsafe 21

3.7 Practice management and internet facility 23

3.8 Use of colleagues and other health professionals 25

3.9 Information sources GPs identified a desire to have access to 26

3.10 Influences on prescribing 26

3.11 Response to clinical cases 27

3.12 Rural and urban practice setting 32

3.13 Age of GP participants 36

3.14 Workload: participant and practice characteristics 40

3.15 Gender of GP participants 41

3.16 New trainees 44

4 Discussion 49

4.1 Prescribing sources used by GPs 49

4.2 How GPs keep up to date 51

4.3 Other factors influencing GP prescribing decisions 52

4.4 Factors influencing best prescribing practice 53

4.5 New trainee GPs 54

4.6 Strengths of this survey 54

4.7 Limitations of this survey 55

5 Conclusions 56

5.1 Policy implications 56

5.2 Future prospects and speculations 57

6 References 58

Appendix 1: Literature review 59

1 Information sources for GPs 59

2 New drug adoption by GPs 61

3 Factors beyond clinical presentation that influence prescribing decisions by GPs 62

Appendix 2: Participant Information Sheet 69

Appendix 3: Data Coding Frames 71

Glossary and List of Acronyms 75




List of Tables

Table 3.1.1: Participant characteristics 13

Table 3.1.2: Practice characteristics 14

Table 3.2.1: Most commonly used data sources when seeking prescribing information 15

Table 3.2.2: Different source to that most commonly used when seeking specific prescribing information 15

Table 3.3.1: Frequency of usage of standard prescribing resources 16

Table 3.3.2: Perceived usefulness of standard prescribing resources 17

Table 3.3.3: Reasons for not using bpacnz 17

Table 3.3.4. bpacnz’s influence on prescribing 18

Table 3.3.5: Summary of why GPs do not use PHARMAC schedules or monthly updates 18

Table 3.4.1: Frequency of use of medical journals for prescribing 18

Table 3.4.2: Use of medical journals for prescribing 19

Table 3.4.3: Use of medical journals for prescribing by place of graduation 20

Table 3.5.1: Frequency of use of prescribing websites 20

Table 3.5.2: Commonly used prescribing websites 21

Table 3.6.1: Frequency of use of Medsafe for prescribing 21

Table 3.6.2: Frequency of use of Medsafe for prescribing by place of graduation 22

Table 3.6.3: Usefulness of Medsafe 22

Table 3.6.4: Usefulness of Medsafe by place of graduation 22

Table 3.6.5: Summary of why GPs do not use Medsafe 23

Table 3.7.1: Degree of computerisation 23

Table 3.7.2: Practice management systems (PMSes) 24

Table 3.7.3: Internet access 24

Table 3.7.4: Internet connection speed 24

Table 3.7.5: Internet connection speed in the consulting room and frequency of use of prescribing websites 25

Table 3.8.1: Frequency and usefulness of colleagues and other health professionals for prescribing 25

Table 3.10.1: Influences on prescribing 27

Table 3.11.1: A 75-year-old with new high blood pressure 180/85 with normal renal function and no contraindication to drugs 28

Table 3.11.2: An eight-year-old with clinical and proven Streptococcal throat with no suggestion of possible penicillin allergy 28

Table 3.11.3: What sources of information would you use to determine which countries have chloroquine-resistant malaria? 28

Table 3.11.4: Where would you go to get information on malaria tablets for children? 29

Table 3.11.5: Where would you go to get information on malaria tablets for a pregnant woman? 30

Table 3.11.6: Comparison of recent trainees with other GPs in relation to recommended prescribing practice 30

Table 3.11.7: Recommended practice prescribing by workload 31

Table 3.11.8: Recommended practice prescribing by place of graduation 31

Table 3.11.9: Recommended practice prescribing by frequency of website use 31

Table 3.11.10: Prescribing by usefulness of pharmaceutical representatives 31

Table 3.11.11: Prescribing and internet connection speed 32

Table 3.12.1: Participant characteristics by practice setting 32

Table 3.12.2: Practice characteristics by practice setting 33

Table 3.12.3: Frequency of use of medical journals for prescribing by practice setting 33

Table 3.12.4: Frequency of use of prescribing websites by practice setting 34

Table 3.12.5: Recommended practice prescribing by practice setting 34

Table 3.12.6: Degree of computerisation by practice setting 34

Table 3.12.7: Practice management systems by practice setting 35

Table 3.12.8: Internet access by practice setting 35

Table 3.12.9: Internet connection speed in the consulting room by practice setting 35

Table 3.13.1: Participant characteristics by age of GP 36

Table 3.13.2: Practice characteristics by age of GP 36

Table 3.13.3: Frequency of use of standard prescribing resources by age of GP 37

Table 3.13.4: Usefulness of standard prescribing resources by age of GP 38

Table 3.13.5: Frequency of use of medical journals for prescribing by age of GP 38

Table 3.13.6: Usefulness of medical journals for prescribing by age of GP 39

Table 3.13.7: Frequency of use of prescribing websites by age of GP 39

Table 3.13.8: Usefulness of Medsafe by age of GP 39

Table 3.13.9: Recommended practice prescribing by age of GP 40

Table 3.13.10: Internet access by age of GP 40

Table 3.14.1: Participant characteristics by workload 40

Table 3.14.2: Practice characteristics by workload 41

Table 3.15.1: Most commonly used sources when seeking prescribing information by gender of GP 42

Table 3.15.2: Different source to that most commonly used when seeking specific prescribing information 42

Table 3.15.3: Frequency of usage of standard prescribing resources by gender of GP 42

Table 3.15.4: Frequency of use of colleagues and other health professionals for prescribing by gender of GP 43

Table 3.16.1: Participant characteristics for new trainee and main sample GPs 44

Table 3.16.2: Practice characteristics for new trainee and main GPs 44

Table 3.16.3: Frequency of usage of standard prescribing resources for new trainee and main GPs 45

Table 3.16.4: Frequency of use of medical journals for prescribing for new trainee and main GPs 46

Table 3.16.5: Frequency of use of prescribing websites for new trainees 46

Table 3.16.6: Frequency of use of Medsafe for prescribing for new trainee and main GPs 46

Table 3.16.7: Internet access for new trainees 48







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