Background 
Recent studies have identified the source of information¹ and the means of communicating it² as important influences in the uptake of new products by doctors. However, there have been no studies, to date, addressing product selection by nurse prescribers. Understanding how nurse prescribers select products will benefit organisations such as primary care trusts (PCTs) charged with improving the quality of prescribing via the clinical governance agenda. This paper reports the findings of a qualitative study investigating product selection by district nurse prescribers. 

Method 
Semi-structured interviews were held with 14 of the 46 district nurse prescribers in one PCT. This PCT was selected as it had no local formulary restricting prescriber choice and was also an original nurse prescribing pilot site where nurse prescribing was well established. This was essentially a convenience sample although nurses were recruited in this study until the full range of prescribing frequencies in this PCT were included [less than 11 items per week (n=2), 11-20 items per week (n=6), 21-30 items per week (n=4) and >31 items per week (n=2)]. Transcriptions of the audiotaped interviews were coded using N-VIVO® software and analysed using the framework method. 

Findings 
The products prescribed immediately following qualification as a prescriber were dependent upon whether they qualified as a district nurse and a prescriber separately or together. Nurses that worked as a district nurse before qualifying as a prescriber, prescribed the same products that they had been asking GPs to prescribe before they qualified. Nurses that qualified as a district nurse and prescriber at the same time prescribed the same products that their mentor prescribed. Many of the nurses had altered their prescribing patterns since they qualified. When describing changes in prescribing patterns they referred to ‘fashion trends’ and were more likely to prescribe products they considered to be ‘fashionable’. The characteristics of ‘fashionable products’ were those that were: 

Nurses changed their prescribing either when a product, already prescribed for an individual patient, was considered ineffective or when they heard of a new product that they considered to be superior to the products they currently prescribed. The subsequent decision to start prescribing a new product regularly was based largely upon the nurse’ own experience of using the new product on one or two patients. 

Discussion 
Prescriber training appears to have little impact upon product selection, which is perhaps not surprising if we accept that prescriber training should deal with how to prescribe rather than what to prescribe. After qualification, changes in prescribing were largely influenced by pharmaceutical industry representatives, colleagues and the nurse’s own experience. It is a concern that fashionable prescribing was mentioned in preference to independently produced evidence-based information and a particular concern was the reliance on information produced by those with a vested interest in prescribing specific products especially considering the doubts expressed over the reliability of this information³. 

References

1. Prosser H, Amond S, Walley T. Influences on GPs’ decision to prescribe new drugs – the importance of who says what. Family Practice 2003; 20 (1): 61-68

2. McGettigan P, Golden J, Fryer J, Chan R, Feely J. Prescribers prefer people: The sources of information used by doctors for prescribing suggest that the medium is more important than the message. British Journal of Clinical Pharmacology 2000; 51: 184-189

3. Villanueva P, Salvador P, Librero J, Pereiro I. Accuracy of pharmaceutical advertisements in medical journals. The Lancet 2003; 361: 27-32