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Right arrow Drugs: infections
CMAJ • July 27, 1999; 161 (2)
© 1999 Canadian Medical Association or its licensors

Evidence
Études

Effects of perceived patient demand on prescribing anti-infective drugs

Elizabeth Miller, MSc, Linda D. MacKeigan, PhD, Walter Rosser, MD and Joan Marshman, PhD

From (Miller, MacKeigan, Marshman) the Faculty of Pharmacy and (Rosser) the Department of Family and Community Medicine, University of Toronto, Toronto, Ont.

Abstract

Background: Although patient demand is frequently cited by physicians as a reason for inappropriate prescribing, the phenomenon has not been adequately studied. The objectives of this study were to determine the prevalence of perceived patient demand in physician-patient encounters; to identify characteristics of the patient, physician and prescribing situation that are associated with perceived demand; and to determine the influence of perceived demand on physicians' prescribing behaviour.

Methods: An observational study using 2 survey approaches was conducted in February and March 1996. Over a 2-day period 20 family physicians in the Toronto area completed a brief questionnaire for each patient encounter related to suspected infectious disease. Physicians were later asked in an interview to select and describe 1 or 2 incidents from these encounters during which perceived patient demand influenced their prescribing (critical incident technique).

Results: Perceived patient demand was reported in 124 (48%) of the 260 physician-patient encounters; however, in almost 80% of these encounters physicians did not think that the demand had much influence on their decision to prescribe an anti-infective. When clinical need was uncertain, 28 (82%) of 34 patients seeking an anti-infective were prescribed one, and physicians reported that they were influenced either "moderately" or "quite a bit" by perceived patient demand in over 50% of these cases. Of the 35 critical prescribing incidents identified during the interviews, anti-infectives were prescribed in 17 (49%); the reasons for prescribing in these situations were categorized.

Interpretation: This study provides preliminary data on the prevalence and influence of perceived patient demand in prescribing anti-infectives. Patient demand had more influence on prescribing when physicians were uncertain of the need for an anti-infective.