@article {Miller139, author = {Elizabeth Miller and Linda D. MacKeigan and Walter Rosser and Joan Marshman}, title = {Effects of perceived patient demand on prescribing anti-infective drugs}, volume = {161}, number = {2}, pages = {139--142}, year = {1999}, publisher = {CMAJ}, 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{\textquoteright} 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.}, issn = {0820-3946}, URL = {https://www.cmaj.ca/content/161/2/139}, eprint = {https://www.cmaj.ca/content/161/2/139.full.pdf}, journal = {CMAJ} }