A qualitative comparative investigation of variation in general practitioners' prescribing patterns.
BACKGROUND
In New Zealand there is increasing interest in the variation in the prescribing behaviours of general practitioners (GPs). Research conducted to date hasfocused primarily on the quantifiable aspects of prescribing variation.


OBJECTIVE
To investigate the qualitative aspects that may help explain variations in prescribing behaviour between GPs.


METHODS
Qualitative and comparative interviews.


METHODS
Thirty New Zealand GPs.


METHODS
A sample of 60 GPs (comprising 20 low, 20 medium, and 20 high-cost prescribers) was selected. Half of this sample (10 GPs in each prescribing category) was recruited to the study. Responders participated in a 60-minute interview.


RESULTS
Low-cost prescribers reported more experience in practice and appeared to have a more 'relaxed' attitude towards medicine. They were more comfortable with refusing patients and they responded to patient expectations with education and explanation. In addition, they viewed the prescription as a pragmatic means of delivering health care to patients. Low and medium-cost prescribers did moreformal counselling and emphasised the 'listening' aspects of general practice. High-cost prescribers appeared to be more highly motivated and to have a more 'serious' attitude toward medicine. They tended to view their obligations and responsibilities to the patient in terms of medical competence. They described their roles with patients in terms of service provision and suggested that patients viewed the prescription as a signifier of the GP's service to the patient.


CONCLUSIONS
This study suggests that there are discernible, non-quantifiable differences between low, medium, and high-cost prescribers in the Otago and Southland areas of New Zealand.
Jaye
Chrys
C
Department of General Practice, Dunedin School of Medicine, University of Otago, New Zealand. cjaye@gp.otago.ac.nz
Tilyard
Murray
M
D001291:Attitude of Health Personnel; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics*; D004363:Drug Utilization / Q000191:economics / Q000706:statistics & numerical data*; D005194:Family Practice / Q000191:economics* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D009520:New Zealand; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*