title: 'Potentially inappropriate or specifically appropriate?' Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people.
abstract: Potentially inappropriate prescribing (PIP) is common in older people in primary care, as evidenced by a significant body of quantitative research. However, relatively few qualitative studies have investigated the phenomenon of PIP and its underlying processes from the perspective of general practitioners (GPs). The aim of this paper is to explore qualitatively, GP perspectives regarding prescribing and PIP in older primary care patients.
  
  
  
  Semi-structured qualitative interviews were conducted with GPs participating in a randomised controlled trial (RCT) of an intervention to decrease PIP in older patients (≥70 years) in Ireland. Interviews were conducted with GP participants (both intervention and control) from the OPTI-SCRIPT cluster RCT as part of the trial process evaluation between January and July 2013. Interviews were conducted by one interviewer and audio recorded. Interviews were transcribed verbatim and a thematic analysis was conducted.
  
  
  
  Seventeen semi-structured interviews were conducted (13 male; 4 female). Three main, inter-related themes emerged (complex prescribing environment, paternalistic doctor-patient relationship, and relevance of PIP concept). Patient complexity (e.g. polypharmacy, multimorbidity), as well as prescriber complexity (e.g. multiple prescribers, poor communication, restricted autonomy) were all identified as factors contributing to a complex prescribing environment where PIP could occur, as was a paternalistic-doctor patient relationship. The concept of PIP was perceived to be of variable usefulness to GPs and the criteria to measure it may be at odds with the complex processes of prescribing for this patient population.
  
  
  
  Several inter-related factors contributing to the occurrence of PIP were identified, some of which may be amenable to intervention. Improvement strategies focused on improved management of polypharmacy and multimorbidity, and communication across primary and secondary care could result in substantial improvements in PIP.
  
  
  
  Current controlled trials ISRCTN41694007.
authors: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland. barbaraclyne@rcsi.ie.
authors: Barbara
authors: B
authors: Clyne
authors: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland.|School of Pharmacy, Queen's University Belfast (QUB), 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
authors: Janine A
authors: JA
authors: Cooper
authors: School of Pharmacy, Queen's University Belfast (QUB), 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
authors: Carmel M
authors: CM
authors: Hughes
authors: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland.
authors: Tom
authors: T
authors: Fahey
authors: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland.
authors: Susan M
authors: SM
authors: Smith
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D015897:Comorbidity; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D057970:Inappropriate Prescribing; D007407:Interviews as Topic; D007494:Ireland; D008297:Male; D026706:Paternalism; D010348:Patient Care Team; D010817:Physician-Patient Relations; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D017009:Professional Autonomy; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic
keywords: Older patients; Polypharmacy; Potentially inappropriate prescribing (PIP); Primary care; Qualitative analysis