Factors determining prescribing decisions in a teaching hospital setting

Objectives: To develop a survey tool and use it to assess prescribers' and pharmacists' opinions of the types and relative importance of factors that influence prescribing. Design, participants and setting: In June 1998, a survey was mailed to all medical (non- surgical) and clinical pharmacy staff at two university teaching hospitals on two common clinical scenarios. The first dealt with Helicobacter pylori eradication followed by an open-ended request for factors important in that individual's choice of eradication regimen, ranked by a scoring system. The second dealt with antibiotic therapy for pneumonia followed by a structured questionnaire examining specific factors in relation to the individual's choice of antibiotic. Main outcome measures: Relative importance of various prescribing factors and whether stated factor rankings were reflected by drug choice. Results: The response rate was 28% (105/374). For the first scenario, efficacy was given the greatest weighting followed by the combination of compliance, tolerability, and adverse effects, then cost and duration of therapy. For the second scenario, efficacy (again), illness severity, drug familiarity and guideline concordance featured prominently in structured responses on factor importance while cost, frequency of administration and drug company promotion were considered less important. There was internal individual consistency between initial antibiotic choice and antibiotic-specific factor weightings for 56% of respondents. Conclusions: Stated prescribing factors followed expected patterns. Of the various factors, efficacy was more important than costs, this being consistent in both the respondent-derived and structured sections of the survey. Drug familiarity and guideline concordance were also important. Many respondents prescribed in a manner consistent with their stated factor rankings. (author abstract)