Context
The past decade has seen many changes in attitudes towards prescribing and medicine taking. Firstly an increased focus on evidence based healthcare has led to routine use of prescribing guidelines, protocols and performance targets¹. Secondly there has been a shift towards patient involvement in prescribing decisions through medicines partnership (concordance)². Both of these approaches are meant to be incorporated within effective medicines management³, but how compatible are they?

Aim
This study looked at the relationship between prescribing guidelines and medicines partnership within primary care. An initial literature review showed theoretical areas of conflict particularly around ‘who makes the prescribing decision?’ and ‘what information is used in decision-making?’⁴. This study aimed firstly to explore these questions with patients, GPs and PCT Prescribing Advisers and secondly to identify attitudes towards prescribing guidelines and medicines partnership.

Method
In-depth, qualitative structured interviews were conducted with 2 PCT Prescribing Advisers, 8 GPs and 16 patients (8 patients taking a lipid lowering (statin) drug and 8 taking a proton pump inhibitor). An interpretive, reflective framework was used with the aim of exploring individual perspectives. The interviews were taped, transcribed in full and analysed by coding according to themes, and comparing both within cases and across groups.

Results
In the majority of cases it was the GP who made the prescribing decision. Many GPs wanted to involve patients more but felt that patients didn’t feel comfortable with making joint decisions. GPs used information from both prescribing guidelines and the patient (psycho-social issues) in their decision-making. They tended to follow guidelines where possible, but often had to make allowances for individual patients. Some cases showed a successful fusion of guidelines and partnership. These cases tended to have firstly a high degree of trust between doctors and patients and secondly the patients’ took on a degree of responsibility for their own health.

Discussion
Patients and healthcare professionals have expectations of each other and the development of trust and understanding with the therapeutic relationship is an important influence on prescribing and medicine taking.

References

1. Muir Gray JA. Evidence-based Healthcare, How to Make Health Policy and Management Decisions. Edinburgh: Churchill Livingstone, 1997.

2. Medicines Partnership Programme. www.medicines-partnership.org. Accessed 07.12.04

3. National Prescribing Centre and National Primary Care Research and Development Centre. Modernising Medicines Management, 2002.

4. Hackwood J., Raynor D.K., Knapp P. Blessed are the decision-makers? Approaches to decision-making in prescribing. IJPP 2003, 11:R93.