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Abstract
Introduction: Spanish GPs are often called upon to issue prescriptions to patients for medicines that others including hospital doctors, other public health service doctors, private doctors and patients themselves have decided they should have. This phenomenon of ‘induced prescription’ is a source of unease and frustration for Spanish GPs, particularly in cases where the GP is not in agreement with the prescription induced. Objective: To quantify the extent of induced prescription (IP) with and without agreement in the Spanish public health service and to examine some of its possible determinants.
Methods: A cross-sectional study of drug utilisation and induced prescription was carried out in 13 Barcelona city primary healthcare centres by 113 general practitioners (GPs). Induced prescription was evaluated as percentage of total prescriptions, source of IP and whether or not the GP was in agreement.
Results: A total of 5427 prescriptions issued to 2618 patients were evaluated. Of these 2469 (45.5%), issued to 1202 patients (45.9%), were deemed to have been induced. Sources of IP were: hospital 46.1% (1025 IP), private practice physician 25.1% (557 IP), public healthcare specialists 23.3% (519 IP) and self-prescription 5.5% (122 IP). Public health service GPs recorded an absolute lack of agreement with the medication prescribed in 510 IP (9.4%).
Conclusions: The proportion of IP was very high which indicates that the GP spent a great deal of his/her time involved with IP (granting or denying). The most important source of IP was the hospital; there is probably a misuse of hospital emergency services and of other levels of healthcare. Coordination between hospitals and GPs does not appear to be adequate. The most important sources of IP with absolute lack of agreement were private practice physicians and self-medication. Lack of agreement is a healthcare, legal and economic problem. GPs should not be charged with the responsibility of every IP.