Why do GPs continue inappropriate hospital prescriptions of proton pump inhibitors? A qualitative study.
BACKGROUND
Inappropriate prescriptions of Proton pump inhibitors (PPIs) initiated in hospitals are frequently continued in primary care. No research has explored why general practitioners (GPs) continue or discontinue inappropriate drug therapy.


OBJECTIVE
This study aims to describe factors and motives associated with the continuation of inappropriate prescriptions of PPIs in primary care.


METHODS
Semi-structured qualitative interviews on basis of a purposive sampling of five GPs who often continued inappropriate prescriptions and five GPs who frequently discontinued inappropriate drug therapy with PPIs (10 GPs total, of which four were female and six male).


RESULTS
Although all GPs enrolled in the study were enthusiastic about the effectiveness of PPIs, differences between the continuing and discontinuing GPs exists in three areas: The two groups varied ( 1 ) in awareness of indications and general attitudes towards prescribing ( 2 ) in perception of the hospital physicians' competence in prescribing and ( 3 ) appreciation of general prescribing conditions in hospitals.


CONCLUSIONS
Differences between the continuing and discontinuing GPs were found in their level of knowledge and their perceptions of the hospital physicians' competence and the threshold to prescribing in hospitals. Financial pressure and possible adverse effects demand a more balanced and evidence-based prescribing of PPIs. Attempts to change behaviour should focus on the GPs' awareness of indications for PPIs, NSAID risks, and prescribing approaches in hospitals. Default prescribing in hospital demands critical examination.
Department of General Practice/Family Medicine, University of Göttingen , Göttingen , Germany.
Matthias
M
Wermeling
Wolfgang
W
Himmel
Gesa
G
Behrens
Dirk
D
Ahrens
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D058005:General Practitioners / Q000592:standards / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006761:Hospitals; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D008297:Male; D010820:Physicians / Q000592:standards / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*
D054328:Proton Pump Inhibitors
general practice; qualitative design and methods; quality of care