A qualitative comparative investigation of variation in general practitioners' prescribing patterns.

BACKGROUND In New Zealand there is increasing interest in the variation in the prescribing behaviours of general practitioners (GPs). Research conducted to date hasfocused primarily on the quantifiable aspects of prescribing variation. AIM To investigate the qualitative aspects that may help explain variations in prescribing behaviour between GPs. DESIGN OF STUDY Qualitative and comparative interviews. SETTING Thirty New Zealand GPs. METHOD A sample of 60 GPs (comprising 20 low, 20 medium, and 20 high-cost prescribers) was selected. Half of this sample (10 GPs in each prescribing category) was recruited to the study. Responders participated in a 60-minute interview. RESULTS Low-cost prescribers reported more experience in practice and appeared to have a more 'relaxed' attitude towards medicine. They were more comfortable with refusing patients and they responded to patient expectations with education and explanation. In addition, they viewed the prescription as a pragmatic means of delivering health care to patients. Low and medium-cost prescribers did moreformal counselling and emphasised the 'listening' aspects of general practice. High-cost prescribers appeared to be more highly motivated and to have a more 'serious' attitude toward medicine. They tended to view their obligations and responsibilities to the patient in terms of medical competence. They described their roles with patients in terms of service provision and suggested that patients viewed the prescription as a signifier of the GP's service to the patient. CONCLUSION This study suggests that there are discernible, non-quantifiable differences between low, medium, and high-cost prescribers in the Otago and Southland areas of New Zealand.