Multiplicity and complexity: a qualitative exploration of influences on prescribing in UK general practice

Objectives Despite widespread availability of evidence-based guidelines to inform rational use medicines, considerable unwarranted variation exists in prescribing. A greater understanding key determinants contemporary prescribing UK general practice could strategies promote This study explored (1) current influences on and (2) the possibility that practice-based pharmacists (PBPs) may contribute engagement with Design Semistructured, telephone interviews a focus group were conducted, audio-recorded transcribed verbatim. Thematic analysis was undertaken. Participants General prescribers: practitioners (GPs), PBPs, nurses. Key informants: individuals within National Health Service (NHS) responsibility for influencing, monitoring measuring Setting practices NHS organisations England. Results Interviews 17 prescribers (GPs (n=6), PBPs nurses (n=5)) 6 informants, one five informants undertaken between November 2018 April 2019. Determinants operating at individual, societal levels impacted guideline use. Prescribers’ professional backgrounds, example, nursing, pharmacy, patient populations pressure perceived as substantial influences, well media portrayal public perceptions medicines. Prescribers identified practice-level prescribing, including culture shared beliefs. tended emphasise higher-level policies, support advice from secondary care generic challenges associated medicines use, multimorbidity. expressed mixed views about potential practice. Conclusion Prescribing is influenced by multiple intersecting factors. Strategies should target modifiable individual levels. Customising medical non-medical maximise their effectiveness.