Hospital doctors’ views of factors influencing their prescribing

Ljungberg, Christina; Lindblad, Åsa Kettis; Tully, Mary P.

doi:10.1111/j.1365-2753.2006.00751.x

Cited by 35 publications

(39 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hospital doctors, too, felt influenced by other colleagues, but not to the extent described in other studies [49, 50]. According to our results, ward physicians and physicians on call sometimes disagreed regarding the use of drugs without discussing these discrepancies with each other.…”

Section: Discussioncontrasting

confidence: 57%

The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study

Weiss

Nau

Glaeske

et al. 2018

Eur J Clin Pharmacol

View full text Add to dashboard Cite

show abstract

Section: Discussioncontrasting

confidence: 57%

The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study

Weiss

Nau

Glaeske

et al. 2018

Eur J Clin Pharmacol

View full text Add to dashboard Cite

show abstract

“…An interview guide was developed based on a literature review and individual face to face conversations with six key informants (hospital doctors), purposively sampled from two hospitals in Western Norway [10, 13, 21, 22]. Open ended questions were used to conduct the conversations.…”

Section: Methodsmentioning

confidence: 99%

An antimicrobial stewardship program initiative: a qualitative study on prescribing practices among hospital doctors

Skodvin

Aase

Charani

et al. 2015

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

BackgroundNorway has a low, but increasing prevalence of resistance and few antimicrobial stewardship initiatives. When developing stewardship interventions, an understanding of the determinants of antimicrobial prescribing is needed. We report on the first qualitative study investigating factors influencing doctors’ antimicrobial prescribing practices in Norwegian hospitals.MethodsQualitative semi-structured interviews were conducted with 15 Norwegian hospital doctors prescribing antimicrobials to adult patients. Interviews were transcribed verbatim and thematic analysis was applied to analyse the data.ResultsColleagues, in particular infectious disease specialists, microbiology test results and the newly published national guideline on antimicrobials were identified as key factors influencing antimicrobial prescribing practices. Delayed availability was a barrier for the utilization of microbiology test results and increasing clinical experience overrides the influence of the national guideline.Patient assessment, informal training by experienced colleagues, and infectious disease specialists replacing managers in promoting prudent prescribing policies, also influenced prescribing practices.ConclusionThis study identified the following contextual factors that need to be addressed when developing antimicrobial stewardship programs in Norway: a common work practice for seeking collegial advice, logistics of microbiology test results, and formal leadership and systematic training on prudence. Other countries initiating stewardship programmes may benefit from performing a similar mapping of facilitators and barriers, to identify important stakeholders and organisational obstacles, before developing sustainable and tailored antimicrobial stewardship interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-015-0065-4) contains supplementary material, which is available to authorized users.

show abstract

“…Colleagues were also quantitatively rated relatively high. The importance of colleagues has also been shown by others (146)(147)(148).…”

Section: Inner Settingmentioning

confidence: 83%

Diffusion, implementation and consequences of new health technology : The cases of biological drugs for rheumatoid arthritis and the Swedish national guidelines

Kalkan¹

2015

Linköping University Medical Dissertations

View full text Add to dashboard Cite

Improvements in health technology raise hopes for better patient outcomes and a more efficient delivery of health care. However, the processes of diffusion and implementation of new health technology have been shown to be complicated and to pose a number of challenges for the healthcare sector. Many at tempts have been made to influence and manage the introduction and diffusion of health technology. One prominent example is the Swedish nat ional guidelines that aim at influencing both clinical and political decision - making in the health sector. The overall aim of this thesis is to describe and analyze the factors influencing the diffusion and economic consequences of the introduction of a new technology with large variations in use, and to explore the process of implementation of nationally produced guidelines as an instrument for improv ing effectiveness and equity. The empirical focus is kept on the biological drugs (bDMARDs) for rheumatoid arthritis (RA), since they implied a substantial treatment change when they were first int roduced and they are relatively costly; and on the national guidelines for cardiac care, since they were the first nat ional guidelines, hence allowing a long-term perspect ive in the exploration of their implementat ion. Paper I presents a register study that uses data from national and regional registries on healt hcare use and work disability of patients with RA and shows that there was a 32 percent increase in the total fixed cost of RA during 1990-2010, mainly after the introduct ion of bDMARDs. Paper II shows that choosing to initiate treatment with bDMARDs varied substantially among 26 rheumatologists presented with hypothetical patient cases, and that there were also disparities between rheumatologists practicing in the same clinic. Paper III presents data from the Swedish Rheumatology Quality Register covering 4010 patients with RA, and shows that when using multivariate logistic regression to adjust for patient characterist ics, disease activity and t he physician’s local context, physician preference was an import ant predict or for prescription of bDMARDs. Paper IV is a qualitative study about prescribing decisions, showing that a constellat ion of various factors and their interact ion influenced the prescribing decisions according to the 26 interviewed rheumatologists. The factors included the individual rheumatologist ’s experiences and perceptions of t he evidence, the structure of the department including responsibility for costs, peer pressure, political and administrative influences, and participat ion in clinical trials. The patient as an actor emerged as an important factor. Paper V is a longitudinal qualitat ive study exploring the responses among four Swedish county councils to the national guidelines for cardiac care through 155 interviews with politicians, administ rators and clinical managers. The results show that unilateral responses to the national guidelines within the county councils have been rare, but there have been at tempts to compromise and to at ...

show abstract

Hospital doctors’ views of factors influencing their prescribing

Cited by 35 publications

References 21 publications

The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study

The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study

An antimicrobial stewardship program initiative: a qualitative study on prescribing practices among hospital doctors

Diffusion, implementation and consequences of new health technology : The cases of biological drugs for rheumatoid arthritis and the Swedish national guidelines

Contact Info

Product

Resources

About