Worlds apart? An exploration of prescribing and medicine –taking decisions by patients, GPs and local policy makers.

Solomon, Josie, Raynor, D, Knapp, P and Atkin, K (2013) Worlds apart? An exploration of prescribing and medicine –taking decisions by patients, GPs and local policy makers. Health Policy, 112 (3). pp. 264-272. ISSN 2013.08.004

Full content URL: https://doi.org/10.1016/j.healthpol.2013.08.004

Documents
Worlds apart? An exploration of prescribing and medicine –taking decisions by patients, GPs and local policy makers
Published Manuscript
[img] PDF
Solomon et al 2013.pdf - Whole Document
Restricted to Repository staff only

300kB
Item Type:Article
Item Status:Live Archive

Abstract

Current healthcare policy in the UK has been shaped by two major forces; increasing accountability to evidence-based standards and increasing patient involvement. Shared decision-making brings the patient into prescribing decisions, and guidelines introduce a third decision-maker, the policy maker, into the doctor–patient consultation. This study explored the decision-making processes used by patients and GPs in comparison to local policy makers.

Method: Qualitative interviews with 8GPs, 14 patients and 2 PCT Prescribing Advisers, followed by quantitative questionnaires completed by 305 GPs and 533 patients.

Results: Patients made individual medicine-taking decisions based on experience, personal financial and human cost, trust and the relational aspects of their interactions with doc- tors over time. In contrast local implementation of prescribing guidelines was based on consideration of financial costs, efficacy and risks, based on objective clinical evidence at a population level. GPs adopted a mid-position between these two polar views.

Guidelines are written from a different perspective to the worldview of patients, and they tend to downplay the criteria most important to patients. This has the potential to have a harmful effect on patients’ medicine-taking and adherence. Paradoxically, enforcing the use of guidelines could inhibit the achievement of guideline targets.

Keywords:prescribing, guidelines, decision-making, trust, mixed methods, adherence
Subjects:A Medicine and Dentistry > A990 Medicine and Dentistry not elsewhere classified
Divisions:College of Science > School of Pharmacy
ID Code:42511
Deposited On:11 Nov 2020 14:28

Repository Staff Only: item control page