title: Family physician attitudes about prescribing using a drug formulary.
abstract: BACKGROUND
  Drug formularies have been created by third party payers to control prescription drug usage and manage costs. Physicians try to provide the best care for their patients. This research examines family physicians' attitudes regarding prescription reimbursement criteria, prescribing and advocacy for patients experiencing reimbursement barriers.
  
  
  METHODS
  Focus groups were used to collect qualitative data on family physicians' prescribing decisions related to drug reimbursement guidelines. Forty-eight family physicians from four Ontario cities participated. Ethics approval for this study was received from the Hamilton Health Sciences/Faculty of Health Sciences Research Ethics Board at McMaster University. Four clinical scenarios were used to situate and initiate focus group discussions about prescribing decisions. Open-ended questions were used to probe physicians' experiences and attitudes and responses were audio recorded. NVivo software was used to assist in data analysis.
  
  
  RESULTS
  Most physicians reported that drug reimbursement guidelines complicated their prescribing process and can require lengthy interpretation and advocacy for patients who require medication that is subject to reimbursement restrictions.
  
  
  CONCLUSIONS
  Physicians do not generally see their role as being cost-containment monitors and observed that cumbersome reimbursement guidelines influence medication choice beyond the clinical needs of the patient, and produce unequal access to medication. They observed that frustration, discouragement, fatigue, and lack of appreciation can often contribute to family physicians' failure to advocate more for patients. Physicians argue cumbersome reimbursement regulations contribute to lower quality care and misuse of physicians' time increasing overall health care costs by adding unnecessary visits to family physicians, specialists, and emergency rooms.
authors.affiliation: 1Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano, Switzerland. suzanne.suggs@lu.unisi.ch
authors.forename: L Suzanne
authors.initials: LS
authors.lastname: Suggs
authors.forename: Parminder
authors.initials: P
authors.lastname: Raina
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.forename: Susan
authors.initials: S
authors.lastname: Grant
authors.forename: Kevin
authors.initials: K
authors.lastname: Skilton
authors.forename: Aimei
authors.initials: A
authors.lastname: Fan
authors.forename: Karen
authors.initials: K
authors.lastname: Szala-Meneok
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D003363:Cost Control / Q000379:methods; D016527:Drug Costs / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000191:economics*; D005260:Female; D017144:Focus Groups; D005569:Formularies as Topic / Q000592:standards*; D017408:Guidelines as Topic / Q000592:standards; D006297:Health Services Accessibility / Q000592:standards; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000592:standards; D008297:Male; D009313:National Health Programs / Q000331:legislation & jurisprudence / Q000592:standards; D009864:Ontario; D010819:Physician's Role / Q000523:psychology; D010821:Physicians, Family / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000592:standards*; D011795:Surveys and Questionnaires