Advertisement

Pharmacy World and Science

, Volume 28, Issue 5, pp 302–308 | Cite as

Pharmaceutical care and its relationship to prescribing behaviour of general practitioners

  • Paul E. M. MuijrersEmail author
  • Richard P. T. M. Grol
  • Jildou Sijbrandij
  • Rob Janknegt
  • J. André Knottnerus
Research Article

Abstract

Objective

To study the correlation between pharmaceutical care and prescribing routines of general practitioners (GPs).

Methods

Cross-sectional study; 201 pharmacies, 408 general practices, The Netherlands, 2000/2001. The variation in prescribing behaviour was characterised using 20 validated prescribing indicators based on general practice guidelines. The general construct ‘adherence to guidelines’ served as the dependent variable and was formed by summing the scores of the prescribing indicators. Four possible determinants of the variation were determined on the basis of survey questions: the construct ‘the pharmacist’s attitude towards pharmaceutical care’, and three partial constructs derived from the pharmacist’s care-providing function: the care for the individual patient, the cooperation with general practitioners and the registration of the care provided. A multiple linear regression analysis was then performed.

Main outcome measure

The weighted score for the prescribing indicators.

Results

The weighted average score for the prescribing indicators was 65% (SD 3.7). The response rate to the survey was 71%. The pharmacist’s attitude to pharmaceutical care, as well as the degree to which the pharmacist provided care for the individual patient, the degree to which he cooperated with the general practitioner and the degree to which he registered the care provided were not correlated with the ‘adherence to guidelines’ by the general practitioner with whom the pharmacist frequently cooperated.

Conclusion

Variations between general practitioners in the quality of prescribing, as measured by their adherence to guidelines, were not correlated with pharmaceutical care by the pharmacist with whom they cooperated on a day-to-day basis.

Keywords

Cooperation General practitioner Indicators Pharmacist Pharmaceutical care Pharmacotherapy Prescribing indicators Prescribing quality The Netherlands 

Notes

Acknowledgements

We thank the community pharmacists who participated in this study.

Funding: Royal Dutch Association for the Advancement of Pharmacy (KNMP) and CZ health insurance company.

References

  1. 1.
    Watkins C, Harvey I, Carthy P, Moore L, Robinson E, Brawn R. Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey. Qual Saf Health Care 2003;12(1):29–34.PubMedCrossRefGoogle Scholar
  2. 2.
    Mantyselka P, Ahonen R, Kumpusalo E, Takala J. Variability in prescribing for musculoskeletal pain in Finnish primary health care. Pharm World Sci 2001;(6):232–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Jones MI, Greenfield SM, Jowett S, Bradley CP, Seal R. Proton pump inhibitors: a study of GPs’ prescribing. Fam Pract 2001;18(3):333–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Bjerrum L, Bergman U . Wide variation in the number of different drugs prescribed by general practitioners. A prescription database study. Scand J Prim Health Care 2000;18(2):94–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Bjerrum L, Sogaard J, Hallas J, Kragstrup J. Polypharmacy in general practice: differences between practitioners. Br J Gen Pract 1999;49(440):195–8.PubMedGoogle Scholar
  6. 6.
    Guillemot D, Carbon C, Vauzelle-Kervroedan F, Balkau B, Maison P, Bouvenot G, Eschwege E. Inappropriateness and variability of antibiotic prescription among French office-based physicians. J Clin Epidemiol 1998;51(1):61–8.PubMedCrossRefGoogle Scholar
  7. 7.
    McBride JE, Pater JL, Dorland JL, Lam YM. Extent and variation of omeprazole prescribing in an elderly population of Ontario. Ann Pharmacother 1997;31(4):411–6.PubMedGoogle Scholar
  8. 8.
    Muijrers PEM, Janknegt R, Sijbrandij J, Grol RP, Knottnerus JA Prescribing indicators. Development and validation of guideline-based prescribing indicators as an instrument to measure the variation in the prescribing behaviour of general practitioners. Eur J Clin Pharmacol 2004;60(10):739–46.PubMedCrossRefGoogle Scholar
  9. 9.
    Lawrence M, Olesen F. Indicators of quality in healthcare. Eur J Gen Pract 1997;3:103–8.CrossRefGoogle Scholar
  10. 10.
    Van Mil JWF. Pharmaceutical care, the future of pharmacy. Theory, research and practice. (Dissertation). University of Groningen. The Netherlands; ISBN: 90-9013367-4, 1997.Google Scholar
  11. 11.
    Van der Heide H, Tinke JL. Facts and figures, cost development of pharmaceutical aid. The Hague, The Netherlands: Foundation for Pharmaceutical Statistics; 1999.Google Scholar
  12. 12.
    Van Mil JW, Dudok van Heel MC, Boersma M, Tromp TF. Interventions and documentation for drug-related problems in Dutch community pharmacies. Am J Health Syst Pharm 2001;58(15):1428–31.PubMedGoogle Scholar
  13. 13.
    De Gier JJ. The Electronic Pharmaceutical Dossier: an effective aid to documenting pharmaceutical care data. Pharm World Sci 1996;18(6):241–3.PubMedCrossRefGoogle Scholar
  14. 14.
    Kirking DM, Thomas JW, Ascione FJ, Boyd EL. Detecting and preventing adverse drug interactions: the potential contribution of computers in pharmacies. Soc Sci Med 1986;22(1):1–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990;47(3):533–43.PubMedGoogle Scholar
  16. 16.
    Hakansson A, Andersson H, Cars H, Melander A. Prescribing, prescription costs and adherence to formulary committee recommendations: long-term differences between physicians in public and private care. Eur J Clin Pharmacol 2001;57(1):65–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Kocken GA. Medication discussion groups in the Netherlands: five years of experience. Med Educ 1999;33(5):390–3.Google Scholar
  18. 18.
    Bradley CP, Taylor RJ, Blenkinsopp A. Primary care–opportunities and threats. Developing prescribing in primary care. BMJ 1997;314(7082):744–7.PubMedGoogle Scholar
  19. 19.
    Matheson C, Bond CM, Mollison J. Attitudinal factors associated with community pharmacists’ involvement in services for drug misusers. Addiction 1999;94(9):1349–59.PubMedCrossRefGoogle Scholar
  20. 20.
    Farris KB, Schopflocher DP. Between intention and behavior: an application of community pharmacists’ assessment of pharmaceutical care. Soc Sci Med 1999;49(1):55–66.PubMedCrossRefGoogle Scholar
  21. 21.
    Odedina FT, Hepler CD, Segal R, Miller D. The Pharmacists’ Implementation of Pharmaceutical Care (PIPC) model. Pharm Res 1997;14(2):135–44.PubMedCrossRefGoogle Scholar
  22. 22.
    Carroll NV. Do community pharmacists influence prescribing? J Am Pharm Assoc (Wash DC) 2003;43(5):612–21.Google Scholar
  23. 23.
    Beney J, Bero LA, Bond C. Expanding the roles of outpatient pharmacists: effects on health services utilisation, costs, and patient outcomes (Cochrane Review). In: The Cochrane Library, vol. 4. Oxford; 2001.Google Scholar
  24. 24.
    Guidelines for ATC classification and DDD assignment. Oslo: World Health Organization Collaborating Centre for Drug Statistics Methodology. 2004. Available at: http://www.whocc.no/atcddd/indexdatabase/index.php. Accessed 1 february 2005.
  25. 25.
    Vektis BV. Externe integratie declaratie farmaceutische hulp. 1995 [External integration of declarations for pharmaceutical help]; available at http://www.vektis.nl/index.php. Accessed 1 February 2005.
  26. 26.
    Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst: Eisen en voorwaarden herregistratie huisartsen. [The Royal Dutch Medical Association: requirements and conditions for reregistration of general practitioners]. Staatscourant 2003;47:18.Google Scholar
  27. 27.
    Muijrers PEM, Knottnerus JA, Sijbrandij J, Janknegt R, Grol RPTM. Changing relationships: attitudes and opinions of general practitioners and pharmacists regarding the role of the community pharmacist. Pharm World Sci 2003;25(5):235–41.PubMedCrossRefGoogle Scholar
  28. 28.
    Muijrers PEM, Knottnerus JA, Sijbrandij J, Janknegt R, Grol RPTM. Pharmacists in primary care. Determinants of the care-providing function of Dutch community pharmacists in primary care. Pharm World Sci 2004;26(5):256–62.PubMedCrossRefGoogle Scholar
  29. 29.
    Olesen F, Vedsted P, Norskov Nielsen J. Change in ranking order of prescribing patterns by age and sex standardization of the practice population. Scand J Prim Health Care 1996;14(3):159–64.PubMedGoogle Scholar
  30. 30.
    Sellors J, Kaczorowski J, Sellors C, Dolovich L, Woodward C, Willan A et al. A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients. Can Med Assoc J 2003;169(1):17–22.Google Scholar
  31. 31.
    Krska J, Cromarty JA, Arris F, Jamieson D, Hansford D, Duffus PR, Downie G, Seymour DG. Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care. Age Ageing 2001;30(3):205–11.PubMedCrossRefGoogle Scholar
  32. 32.
    Bernsten C, Bjorkman I, Caramona M, Crealey G, Frokjaer B, Grundberger E, et al. Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in seven European countries. Drugs Aging 2001;18:63–77.PubMedCrossRefGoogle Scholar
  33. 33.
    De Vries CS. Collaboration in healthcare. The tango to drug safety. Dissertation. University of Groningen. The Netherlands;1998Google Scholar
  34. 34.
    Hamley JH, MacGregor SH, Dunbar JA, Cromarty JA. Integrating clinical pharmacists into the primary health care team: a framework for rational and cost-effective prescribing. Scott Med J 1997;42(1):4–7.PubMedGoogle Scholar
  35. 35.
    Muijrers PEM, Knottnerus JA, Sijbrandij J, Janknegt R, Grol RPTM. Differences in prescribing between general practitioners. Impact of the cooperation with pharmacists and impact of visits from pharmaceutical industry representatives. Fam Pract (In press, accepted for publication June 29th 2005).Google Scholar
  36. 36.
    Van Dijk L, Barnhoorn H, De Bakker D. Het Farmacotherapie Overleg in 1999, stand van zaken en effecten op voorschrijven [The Pharmacotherapeutic audit meeting in 1999, current state of affairs and effects on prescribing]. Nivel, Utrecht, The Netherlands; 2001.Google Scholar
  37. 37.
    Nathan A, Sutters CA. A comparison of community pharmacists’ and general practitioners’ opinions on rational prescribing, formularies and other prescribing related issues. J R Soc Health 1993;113:302–7.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Paul E. M. Muijrers
    • 1
    Email author
  • Richard P. T. M. Grol
    • 2
    • 3
  • Jildou Sijbrandij
    • 4
  • Rob Janknegt
    • 5
  • J. André Knottnerus
    • 6
  1. 1.Division HealthcareCZ Health Insurance CompanySittardThe Netherlands
  2. 2.Centre for Quality of Care Research (WOK)Maastricht UniversityMaastrichtThe Netherlands
  3. 3.University of NijmegenNijmegenThe Netherlands
  4. 4.Centre for Data and Information ManagementMaastricht UniversityMaastrichtThe Netherlands
  5. 5.Department of Clinical Pharmacy and ToxicologyMaasland HospitalSittardThe Netherlands
  6. 6.Netherlands School of Primary Care ResearchMaastricht UniversityMaastrichtThe Netherlands

Personalised recommendations