Eccles M P, Soutter J, Bateman D N, Campbell M, Smith J M
Centre for Health Services Research, University of Newcastle upon Tyne.
Br J Gen Pract. 1996 May;46(406):287-90.
The experience from general practice fundholding suggests that financial incentives may influence prescribing; guidelines and hospital prescribing are two other suggested influences.
A study was undertaken to establish general practitioners' attitudes to a financial prescribing incentive scheme, the presence and use of guidelines, and the influence of prescribing initiated within secondary care.
A postal questionnaire survey of non-fundholding general practices in the former Northern Region was conducted.
Practices' thinking and subsequent decisions about the incentive prescribing scheme were most often influenced by discussions within the practice (45%). Those practices that achieved their savings under the incentive scheme were less likely than those not achieving savings to feel that the target was not achievable, the time scale was unacceptable, and that the philosophy behind the scheme was unacceptable. Forty-five per cent of practices received advice from neither a medical nor a pharmaceutical adviser; 27% of practices received advice from both, 12% from a medical adviser only and 16% from a pharmaceutical adviser only. Of the practices that tried to make their target savings, 91% intended to increase generic prescribing; fewer than one-third of practices mentioned any other measure. Prescribing guidelines were reported by a minority of practices, although reported rates of use were high when these were present. Clinical guidelines for three conditions, asthma, diabetes and hypertension, were present in more than 50% of practices; 25% of practices had no clinical guidelines. Hospital prescribing was reported as 'always' or 'usually' influencing prescribing for diabetes by 57% of respondents, ischaemic heart disease by 55%, peptic ulceration by 49%, asthma by 42% and hypertension by 39%.
General practitioner prescribing is influenced by a complex web of factors, with no single factor pre-eminent. To understand this area further, there is a need to take each of these areas and ascertain the match between doctors' perceptions and actual practice.
全科医疗基金持有计划的经验表明，经济激励可能会影响处方开具；指南和医院处方开具是另外两个被认为有影响的因素。
开展一项研究以确定全科医生对经济处方激励计划的态度、指南的存在及使用情况，以及二级医疗中发起的处方开具的影响。
对原北部地区非基金持有型全科医疗进行了邮寄问卷调查。
各医疗机构对激励处方计划的想法及后续决策最常受到机构内部讨论的影响（45%）。在激励计划下实现节余的医疗机构比未实现节余的医疗机构更不容易认为目标无法实现、时间范围不可接受以及该计划背后的理念不可接受。45%的医疗机构既未从医学顾问也未从药学顾问处获得建议；27%的医疗机构从两者处均获得建议，12%仅从医学顾问处获得建议，16%仅从药学顾问处获得建议。在试图实现目标节余的医疗机构中，91%打算增加通用名药物的处方开具；提及任何其他措施的医疗机构不到三分之一。少数医疗机构报告有处方指南，不过当有这些指南时，报告的使用率很高。超过50%的医疗机构有针对哮喘、糖尿病和高血压三种病症的临床指南；25%的医疗机构没有临床指南。57%的受访者报告医院处方开具“总是”或“通常”会影响糖尿病的处方开具，55%影响缺血性心脏病，49%影响消化性溃疡，42%影响哮喘，39%影响高血压。
全科医生的处方开具受到复杂因素网络的影响，没有单一因素占主导地位。为了进一步了解这一领域，有必要对每个领域进行研究，并确定医生认知与实际做法之间的匹配情况。
