title: The compatibility of prescribing guidelines and the doctor-patient partnership: a primary care mixed-methods study.
abstract: BACKGROUND
  UK policy expects health professionals to involve patients in decisions about their care (including medicines use) and, at the same time, to follow prescribing guidelines. The compatibility of these approaches is unclear.
  
  
  OBJECTIVE
  To explore the  relationship between prescribing guidelines and patient-partnership by exploring the attitudes of patients, GPs and primary care trust (PCT) prescribing advisors.
  
  
  METHODS
  A mixed-methods study using qualitative, semi-structured interviews followed by a quantitative,  questionnaire survey in primary care in Northern England.
  
  
  METHODS
  Interviews were conducted with 14 patients taking a statin or a proton pump inhibitor, eight GPs and two prescribing advisors. A multi-variate sampling strategy was used. Qualitative findings were analysed  using framework analysis. Questionnaires based on themes derived from the interviews were distributed to 533 patients and 305 GPs of whom 286 (54%) and 142 (43%) responded.
  
  
  RESULTS
  Areas of tension between guidelines and patient partnership were identified, including potential  damage to trust in the doctor and reduced patient choice, through the introduction of the policy maker as a third stakeholder in prescribing decisions. Other areas of tension related to applying single condition guidelines to patients with multiple illnesses, competition for doctors' time  and the perception of cost containment. Many GPs coped with these tensions by adopting a flexible approach or prioritising the doctor-patient relationship over guidelines.
  
  
  CONCLUSIONS
  Rigidly applied guidelines can limit patient choice and may damage the doctor-patient  relationship. GPs need flexibility in order to optimise the implementation of prescribing guidelines, while responding to individuals' needs and preferences.
authors.affiliation: Leicester School of Pharmacy, De Montfort University, Leicester. jsolomon@dmu.ac.uk
authors.forename: Josie
authors.initials: J
authors.lastname: Solomon
authors.forename: David K
authors.initials: DK
authors.lastname: Raynor
authors.forename: Peter
authors.initials: P
authors.lastname: Knapp
authors.forename: Karl
authors.initials: K
authors.lastname: Atkin
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003657:Decision Making; D004739:England; D019317:Evidence-Based Medicine; D005194:Family Practice; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D010349:Patient Compliance; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011795:Surveys and Questionnaires
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D054328:Proton Pump Inhibitors