Prescribing at the hospital-general practice interface. II: Impact of hospital outpatient dispensing policies in England on general practitioners and hospital consultants.
OBJECTIVE
To assess the impact on general practitioners and hospital consultants of hospital outpatient dispensing policies in England.


METHODS
Postal questionnaire and telephone interview survey of general practitioners and hospital consultants in January 1991.


METHODS
94 selected major acute hospitals in England.


METHODS
20 general practitioners in the vicinity of each of 94 selected hospitals and eight consultants from each, selected by chief pharmacists.


METHODS
Proportions of general practitioners unable to assume responsibility for specialist drugs and of consultants wishing to retain responsibility; association between dispensing restrictions and the frequency of general practitioners being asked to prescribe hospital initiated treatments.


RESULTS
Completed questionnaires were obtained from 1207 (64%) of 1887 general practitioners and 457 (63%) of 729 consultants. 570 (46%) general practitioners felt unable to take responsibility for certain treatments, principally because of difficulty in detecting side effects (367, 30%), uncertainty about explaining treatment to patients (332, 28%), and difficulty monitoring dosage (294, 24%). Among consultants 328 (72%) wished to retain responsibility, principally because of specialist need for monitoring (93, 20%), urgent need to commence treatment (64, 14%), and specialist need to initiate or stabilise treatment (63, 14%). The more restricted the drug supply to outpatients, the more frequently consultants asked general practitioners to prescribe (p less than 0.01) and complete a short course of treatment initiated by the hospital (p less than 0.001).


CONCLUSIONS
Restrictive hospital outpatient dispensing shifts clinical responsibility on to general practitioners. Hospital doctors should be able to retain responsibility for prescribing when the general practitioner is unfamiliar with the drug or there is a specialist need to initiate, stabilise, or monitor treatment.
Sibbald
B
B
Department of General Practice and Primary Care, St George's Hospital Medical School, London.
Wilkie
P
P
Raftery
J
J
Anderson
S
S
Freeling
P
P
D001291:Attitude of Health Personnel; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004739:England; D006801:Humans; D007400:Interprofessional Relations; D008505:Medical Staff, Hospital; D008511:Medicine / Q000706:statistics & numerical data; D016134:Organizational Policy; D010045:Outpatients; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010821:Physicians, Family; D013038:Specialization; D011795:Surveys and Questionnaires