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General Practice

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

BMJ 1996; 312 doi: (Published 13 April 1996) Cite this as: BMJ 1996;312:949
  1. David Armstrong, reader in sociology as applied to medicinea,
  2. Hugh Reyburn, research fellowa,
  3. Roger Jones, Wolfson professor of general practicea
  1. a Department of General Practice, United Medical and Dental School of Guy's and St Thomas's, London SE11 6SP
  1. Correspondence to: Professor Jones.
  • Accepted 14 March 1996


Objectives: To explore general practitioners' reasons for recent changes 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 and five specific changes that had occurred in their prescribing in the preceding six months. The most frequently mentioned changes related to fluoxetine, angiotensin converting enzyme inhibitors, and the antibiotic treatment of Helicobacter pylori. Three models of change were identified: an accumulation model, in which the volume and authority of evidence were important; a challenge model, in which behaviour change followed a dramatic or conflictual clinical event; and a continuity model, in which change took place against a background of willingness to change, modulated by other factors such as cost pressures and the comprehensible therapeutic action of a drug. Behaviour change was reinforced and sustained by experiences with individual patients.

Conclusions: Multiple factors are involved in general practitioners' decisions to change their prescribing habits. Three models of change can be identified which have important implications for the design and evaluation of interventions aimed at behaviour change.

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


  • Funding HR was supported by a grant from Lambeth, Southwark, and Lewisham Family Health Services Authority.

  • Conflict of interest None.

  • Accepted 14 March 1996
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