Clinician attitudes towards prescribing and implications for interventions in a multi-specialty group practice.
BACKGROUND
Prescribing decisions are subject to a myriad of external forces, including patient requests for advertised medications. Although numerous factors influence prescribing, resources to support unbiased evidence-based prescribing are not widely available.


METHODS
To guide future interventions, we surveyed clinicians about influences on prescribing, awareness of pharmaceutical costs and attitudes towards computerized decision support. A 21-item survey was sent to 604 prescribing clinicians in a large multi-specialty group practice that employs a robust electronic medical record.


RESULTS
Surveys were returned from 405 clinicians (67%). Most respondents (87%) felt that direct-to-consumer (DTC) advertising prompts patients to request inappropriate medications, and more than one in five clinicians (22%) reported difficulty declining patients' requests for advertised medications. Providers with more clinical sessions per week reported greater difficulty. Although 93% of clinicians felt they have access to the information needed to guide prescribing, only about half (54%) reported they are aware of how much patients pay for prescription medications. Clinicians' awareness of medication costs varied considerably by specialty, with behavioural health clinicians being the most aware. The majority of providers (79%) stated that computerized prescribing alerts are a clinically useful source of information.


CONCLUSIONS
Although the majority of clinicians reported that DTC advertising leads many patients to request medications that are inappropriate for their condition, a sizable proportion of clinicians reported difficulty declining these requests, and many are unaware of medication costs. Interventions to support prescribing decisions should provide the busiest clinicians with up-to-date, specialty-specific evidence and cost information.
Fortuna
Robert J
RJ
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA. rfortuna@partners.org
Ross-Degnan
Dennis
D
Finkelstein
Jonathan
J
Zhang
Fang
F
Campion
Francis X
FX
Simon
Steven R
SR
D000328:Adult; D000329:Advertising; D000368:Aged; D001291:Attitude of Health Personnel; D004345:Drug Industry / Q000458:organization & administration; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006123:Group Practice / Q000706:statistics & numerical data*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008511:Medicine; D008875:Middle Aged; D009722:Nurse Practitioners; D010465:Perception; D010823:Physician Assistants; D010820:Physicians; D011306:Prescription Fees; D011364:Professional Practice / Q000706:statistics & numerical data; D017010:Reminder Systems; D013038:Specialization; D055815:Young Adult