title: General practitioners' views on using a prescribing substitution application (ScriptSwitch(®)).
abstract: BACKGROUND
  General practitioners (GPs) are increasingly pressured to prescribe cost-effectively, due to rising prescribing expenditure and limited budgets. A computerised prescribing substitution application (ScriptSwitch(®)) provides 'pop-ups' of cost-saving drug switches at the point of prescribing. It has been used by some United Kingdom local health commissioning organisations as part of a medicines management strategy.
  
  
  OBJECTIVE
  To explore GPs' views on using this prescribing substitution application in their day-to-day clinical practice.
  
  
  METHODS
  Qualitative study employing face-to-face semi-structured interviews, undertaken with a convenience sample of eight GPs across five practices within one local health commissioning area in the North of England. Interviews were audio-recorded, transcribed verbatim and thematically analysed.
  
  
  RESULTS
  Six themes were identified including: (1) GPs' acceptance, (2) the application's impact, (3) external control, (4) disruption to workflow, (5) GP willingness to switch and (6) patient willingness to switch.
  
  
  CONCLUSIONS
  Clinician, patient and organisational factors were identified which were assumed by GPs to affect the engagement with the application. Despite general acceptance of the application to enhance cost-effective prescribing, its impact was perceived to be limited within the context of existing cost-effective prescribing initiatives. The application's perceived lack of 'learning'-e.g. offering the same switch despite the prescriber repeatedly declining this-devalued users' confidence in it. With patients varying in amenability and acceptance to drug switches, GPs appear to experience tension between considering individual patient choice and wider practice population prescribing priorities. Giving GPs more control in adapting the application to their own local prescribing priorities may enhance its success.
authors.affiliation: Academic Unit of Primary Care, Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, UK. um08ch@leeds.ac.uk.
authors.forename: Carly
authors.initials: C
authors.lastname: Hire
authors.affiliation: Academic Unit of Primary Care, University of Leeds, UK.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rushforth
mesh_terms: D001291:Attitude of Health Personnel; D011307:Drug Prescriptions; D057915:Drug Substitution / Q000191:economics; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D006113:United Kingdom; D014584:User-Computer Interface