Factors influencing adherence to guidelines in general practice.

OBJECTIVES To identify and assess the effects of general practitioner and patient characteristics on global adherence to pharmacotherapeutic guidelines. METHODS In a cross-sectional study in the northern Netherlands, a two-level multilevel model was applied to patients (n = 269,067) in 190 practices with a total of 251 general practitioners. The dependent variable was the global adherence to pharmacotherapeutic guidelines as a measure of good prescribing in a general practice setting. RESULTS The mean global adherence was 82%. Two general practice variables, organization form and degree of urbanization influenced the global adherence, whereas all patient variables (age and gender) and the patient-related prescription characteristics (costs, volume, different ATC-codes) were significant predictors for the global adherence. The total explained variance was 28%. CONCLUSIONS Patient characteristics have a greater influence on prescribing behavior than general practitioner characteristics.