An ethnographic exploration of influences on prescribing in general practice: why is there variation in prescribing practices?

摘要: Background: Prescribing is a core activity for general practitioners, yet significant variation in the quality of prescribing has been reported. This suggests there may be room improvement application current best research evidence. There substantial investment technologies and interventions to address this issue, but effect sizes so far have small moderate. that decision-making process not sufficiently understood. By understanding more about processes implementation evidence, easily understood effective proposed. Methods: An ethnographic study three Scottish practices with diverse organizational characteristics. Practices were ranked by their performance against Audit Scotland indicators, incorporating established Two high one practice low recruited. Participant observation, formal informal interviews, review documentation employed. Results: as consistently made applied macro micro decisions, whereas low-ranking only decisions. Macro decisions collective, policy considering evidence light average patient, disease, condition, or drug. Micro consultation patient views, preferences, circumstances other conditions (if necessary). Although can operate independently, evidence-based, was attributable an interdependent relationship. enabled based on scientific where possible. Ultimately, influenced occur at level patients. Conclusion: General practitioners higher two different ‘types’ decision; micro. informs without basis draw upon low-ranked had no mechanism engage with, reflect implement relevant recognize these levels decision making are likely able