A study of general practitioners' reasons for changing their prescribing behaviour

BMJ 1996;312:949-952 (13 April)

General practice

A study of general practitioners' reasons for changing their prescribing behaviour

David Armstrong, reader in sociology as applied to medicine,^a Hugh Reyburn, research fellow,^a Roger Jones, Wolfson professor of general practice ^a

^a Department of General Practice, United Medical and Dental School of Guy's and St Thomas's, London SE11 6SP

Correspondence to: Professor Jones.

Abstract

Objectives : To explore general practitioners' reasons for recentchanges in their prescribing behaviour.
Design : Qualitative analysis of semistructured interviews.
Setting : General practice in south east London.
Subjects : A heterogeneous sample of 18 general practitioners.
Results : Interviewees were able to identify between two andfive specific changes that had occurred in their prescribingin the preceding six months. The most frequently mentioned changesrelated to fluoxetine, angiotensin converting enzyme inhibitors,and the antibiotic treatment of Helicobacter pylori. Three modelsof change were identified: an accumulation model, in which thevolume and authority of evidence were important; a challengemodel, in which behaviour change followed a dramatic or conflictualclinical event; and a continuity model, in which change tookplace against a background of willingness to change, modulatedby other factors such as cost pressures and the comprehensibletherapeutic action of a drug. Behaviour change was reinforcedand sustained by experiences with individual patients.
Conclusions : Multiple factors are involved in general practitioners'decisions to change their prescribing habits. Three models ofchange can be identified which have important implications forthe design and evaluation of interventions aimed at behaviourchange.

Key messages

Key messages
General practitioners respond to different types of cue to change their prescribing
Many change agents seem to have their power through surprise or conflict and it may be possible to simulate therapeutic challenges together with appropriate educational support
The traditional agencies of change--clinical meetings, journal editorials, and so on--cannot be expected to bring about change on a large scale; at best they can help prepare the ground
Change is initially precarious and needs reinforcement if it is to be maintained

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