title: Rationalising prescribing: Evidence, marketing and practice-relevant knowledge.
abstract: Initiatives in the name of 'rational pharmacotherapy' have been launched to alter what is seen as 'inappropriate' prescribing practices of physicians. Based on observations and interviews with 20 general practitioners (GPs) in 2009-2011, we explored how attempts to rationalise prescribing interact with chronic care management in Denmark. We demonstrate how attempts to rationalise prescribing by informing GPs about drug effects, adverse effects and price do not satisfy GPs' knowledge needs. We argue that, for GPs, 'rational' prescribing cannot be understood in separation from the processes that enable patients to use medication. Therefore, GPs do much more to obtain knowledge about medications than seek advice on 'rational pharmacotherapy'. For instance, GPs also seek opportunities to acquaint themselves with the material objects of medication and medical devices. We conceptualise the knowledge needs of GPs as a need for practice-relevant knowledge and argue that industry sales representatives are granted opportunity to access general practice because they understand this need of GPs.
authors.affiliation: Center for Healthy Aging, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5B, PO Box 2099, DK-1014 Copenhagen, Denmark. Electronic address: sala@sund.ku.dk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wadmann
authors.affiliation: Department of Cardiology, The Heart Center, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
authors.forename: Lia E
authors.initials: LE
authors.lastname: Bang
mesh_terms: D002983:Clinical Competence; D003718:Denmark; D011307:Drug Prescriptions; D004363:Drug Utilization; D019317:Evidence-Based Medicine; D058005:General Practitioners / Q000193:education; D066296:Grounded Theory; D006801:Humans; D007407:Interviews as Topic; D040541:Marketing; D010818:Practice Patterns, Physicians'
keywords: Clinical decision-making; Denmark; Evidence-based medicine (EBM); Governance; Medical marketing; Practice-relevant knowledge; Prescribing; Rational pharmacotherapy