GPs’ perspectives on prescribing for older people in primary care: a qualitative study

Problem

Providing optimal care for older people creates many challenges for healthcare providers especially general practitioners (GPs). Appropriate prescribing of medications is a significant challenge as older people can present with multiple conditions for which multiple medications are often required. As a result, medication related problems are common and are associated with morbidity, adverse drug events, extended hospital stays and mortality.As the main prescribers of medication in primary care, GPs are an obvious source of information to better understand the complexities of prescribing for these patients. Understanding the determinants of GP behaviour in relation to prescribing is a first step in the development of interventions to address the issue of medication related problems. The aim of the study is to determine the key theoretical domains that influence GP prescribing for those over 65 years in primary care.

Approach

This study was conducted in one geographical region in the Republic of Ireland. Qualitative semi-structured interviews were conducted with 16 GPs at a date and time convenient for them. The Framework approach was used to analyse the data. Emerging themes were mapped to the Theoretical Domains Framework (TDF), a tool used to apply behaviour change theories. To enhance the validity of coding, three coders from different professional backgrounds independently coded a sample of the transcripts. Demographic information from each transcript was analysed using Microsoft Excel. The consolidated criteria for reporting qualitative research (COREQ) statement was used for explicit and comprehensive reporting of the findings.

Findings

The preliminary findings of the study have identified the following domains as being important determinants of GPs’ prescribing behaviour: “Skills”, “Reinforcement”, “Goals”, “Social influences”, “Emotion” and “Behavioural Regulation”. As the number of older people is increasing participants believe they will need to improve their skills in the area of Gerontology. Prescribing in primary care was highlighted as a concern due to its association with litigation. It was widely acknowledged that the common goal among participants is patient safety. Participants admitted that older people can have health expectations and often try to influence their prescribing. Prescribing for older people is a concern for participants as they have to consider many factors such as comorbidities, side-effects, drug interactions, renal function and compliance. Finally, the prospect of a community pharmacist auditing GP prescribing of older people was widely welcomed by participants, however a lack of funding for this service was acknowledged.

Consequences

These preliminary findings highlight that prescribing for older people in primary care is a source of anxiety and a huge workload for GPs. Targeting the domains above may address these negative associations and improve outcomes for patients.