"Psychiatry is not a science like others" - a focus group study on psychotropic prescribing in primary care.
BACKGROUND
Psychotropic drug prescribing is problematic and knowledge of factors affecting the initiation and maintenance of such prescribing is incomplete. Such knowledge could provide a basis for the design of interventions to change prescribing patterns for psychotropics. The aim of this study was to explore the views of general practitioners (GPs), GP interns, and heads of primary care units on factors affecting the prescribing of psychotropic drugs in primary care.


METHODS
We performed four focus group discussions in Gothenburg, Sweden, with a total of 21 participants (GPs, GP interns, and heads of primary care units). The focus group discussions were transcribed verbatim and analyzed using manifest content analysis.


RESULTS
Three different themes emerged from the focus group discussions. The first theme Seeking care for symptoms, reflects the participants' understanding of why patients approach primary care and comprised categories such as knowledge, attitudes, and society and the media. The second theme, Lacking a framework, resources, and treatment alternatives, which reflects the conditions for the physician-patient interaction, comprised categories such as economy and resources, technology, and organizational aspects. The third theme, Restricting or maintaining prescriptions, with the subthemes Individual factors and External influences, reflects the physicians' internal decision making and comprised categories such as emotions, knowledge, and pharmaceutical industry.


CONCLUSIONS
The results of the present study indicate that a variety of factors may affect the prescribing of psychotropic medications in primary care. Many factors were related to characteristics of the patient, the physician or their interaction, rather than the patients' medical needs per se. The results may be useful for interventions to improve psychotropic prescribing in primary care.
Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Sweden. tove.hedenrud@socmed.gu.se
Tove M
TM
Hedenrud
Staffan A
SA
Svensson
Susanna M
SM
Wallerstedt
D000288:Administrative Personnel / Q000523:psychology; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000523:psychology*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000523:psychology; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D011570:Psychiatry / Q000379:methods / Q000592:standards; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012924:Social Conditions; D061108:Social Media; D013548:Sweden; D000078329:Workforce
D011619:Psychotropic Drugs