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Prerequisites and Responsibility for Appropriate Prescribing – the Prescribers’ View

by Ljungberg, Christina, PhD

Abstract (Summary)
The overall aim of this thesis was to explore aspects of the subjective views and experiences of doctors in their role as prescribers. Prescribing is a well-studied subject, but qualitative studies are less common. Nonetheless, they provide important insights into the prescriber’s perspective.In the first studies secondary care doctors’ perceptions of influences in prescribing and views of appropriate prescribing were investigated in interviews. Among the influences in prescribing were guidelines, colleagues and therapeutic traditions. The doctors perceived that appropriate prescribing needed continuous revision. From the perspective of the prescribers the definition of appropriate prescribing could be rephrased as: “the outcome of the recurring processes of decision making that maximises net individual health gains within society’s available resources”.In the subsequent studies in this thesis the experiences of exchanging information regarding a patient’s drugs in an electronic patient medical record (e-PMR) shared between primary and secondary care and views of responsibility was explored, using focus groups with both primary and secondary care doctors. Considering the gap between primary and secondary care, doctors’ views of responsibility in prescribing and exchange of information are of concern. According to the doctors the shared e-PMR could be an important tool, but not the solution, for appropriate prescribing including ongoing revisions. The e-PMR had an abundance of data and information, but not always the more summarised knowledge needed to be actively documented for the next caregiver. Taking responsibility for the patient’s drugs was defined as going through the list of medications and updating it. However, although taking the time to review all the patient’s medications was regarded as important, it was described as difficult in daily practice. Ongoing revision and evaluation of drug therapy is described as unaccomplished and appropriate prescribing is thus not achieved, according to the doctors’ own descriptions of the concept. 
Bibliographical Information:

Advisor:

School:Uppsala universitet

School Location:Sweden

Source Type:Doctoral Dissertation

Keywords:PHARMACY; Community pharmacy services; computer-assisted drug therapy; prescription drugs; physician's practice patterns; drug prescriptions; computerised medical records systems; continuity of patient care; hospital medication systems; drug utilisation review; responsibility; Samhällsfarmaci; Social Pharmacy

ISBN:978-91-554-7807-0

Date of Publication:01/01/2010

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