title: The impact of specialists on prescribing by general practitioners.
abstract: OBJECTIVE
  To investigate the direct impact of specialists on prescribing by general practitioners.
  
  
  METHODS
  Cross-sectional, prescription-based study.
  
  
  METHODS
  88 GPs in the Hunter Urban Division of General Practice, Hunter Valley, NSW.
  
  
  METHODS
  Proportions of specialist-initiated prescriptions for eight commonly prescribed drug classes.
  
  
  RESULTS
  The proportion of specialist-initiated prescriptions was greatest for proton pump inhibitors (85%), and lowest for diuretics (8%), newer antidepressants (10%) and H2-receptor antagonists (13%). Specialists initiated 29% of prescriptions for beta-blockers, 26% for calcium-channel blockers, 20% for statins and 19% for angiotensin-converting enzyme inhibitors or angiotensin II antagonists. Specialists were more likely to have been involved in starting therapy with metoprolol than other beta-blockers (51% v 23%) and diltiazem than other calcium-channel blockers (48% v 19%), and this was related to indication for treatment. In contrast, prescriptions for the more recently introduced drugs (angiotensin II antagonists and atorvastatin) were not more likely to have been specialist-initiated than prescriptions for established angiotensin-converting enzyme inhibitors and statins.
  
  
  CONCLUSIONS
  The direct impact of specialists on prescribing in the Hunter Urban Division of General Practice is substantial and varies with the drug class. This highlights the need to engage both GPs and specialists in efforts to improve prescribing practices.
authors.affiliation: Discipline of Clinical Pharmacology, School of Population Health Sciences, Faculty of Medicine and Health Sciences, University of Newcastle, NSW.
authors.forename: J
authors.initials: J
authors.lastname: Robertson
authors.forename: J L
authors.initials: JL
authors.lastname: Fryer
authors.forename: D L
authors.initials: DL
authors.lastname: O'Connell
authors.forename: A
authors.initials: A
authors.lastname: Sprogis
authors.forename: D A
authors.initials: DA
authors.lastname: Henry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003625:Data Collection; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D009517:New South Wales; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D013038:Specialization