title: The prescribing of specialist medicines: what factors influence GPs' decision making?
abstract: BACKGROUND
  As Governments worldwide strive to integrate efficient health care delivery across the primary-secondary care divide, particular significance has been placed on the need to understand GPs' prescribing of specialist drugs.
  
  
  OBJECTIVE
  To explore the factors which influence GPs' decision-making process when requested to prescribe specialist drugs.
  
  
  METHODS
  A qualitative approach was used to explore the perspectives of a wide range of practice-, primary care trust-, strategic health authority-level staff and other relevant stakeholders in the North-West of England. All semi-structured interviews (n = 47) were analysed comprehensively using the five-stage 'framework' approach.
  
  
  RESULTS
  Six diverse factors were identified as having a crucial bearing on how GPs evaluate initial requests and subsequently decide whether or not to prescribe. These include GPs' lack of knowledge and expertise in using specialist drugs, the shared care arrangement, the influence of a locally agreed advisory list, financial and resource considerations, patient convenience and understanding and GPs' specific areas of interest.
  
  
  CONCLUSIONS
  This exploration of GPs' decision-making process is needed to support future integrated health care delivery.
authors.affiliation: Division of Primary Care, School of Community Health Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK. sarah.crowe@nottingham.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Crowe
authors.forename: Mary P
authors.initials: MP
authors.lastname: Tully
authors.forename: Judith A
authors.initials: JA
authors.lastname: Cantrill
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D005194:Family Practice / Q000379:methods*; D006801:Humans; D007400:Interprofessional Relations; D008505:Medical Staff, Hospital; D054539:Medication Therapy Management / Q000458:organization & administration; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs / Q000008:administration & dosage*; D055656:Prescriptions; D013222:State Medicine; D006113:United Kingdom
chemical_list: D055553:Prescription Drugs