چکیده (انگلیسی):

Background:Potentially inappropriate prescribing (PIP) is common in older people in primary care, as
evidenced by a significant body of quantitative research. However, relatively few qualitative studies have
investigated the phenomenon of PIP and its underlying processes from the perspective of general
practitioners (GPs). The aim of this paper is to explore qualitatively, GP perspectives regarding prescribing and PIP
in older primary care patients.
Method:Semi-structured qualitative interviews were conducted with GPs participating in a randomised controlled trial
(RCT) of an intervention to decrease PIP in older patients (≥70 years) in Ireland. Interviews were conducted with GP
participants (both intervention and control) from the OPTI-SCRIPT cluster RCT as part of the trial process evaluation
between January and July 2013. Interviews were conducted by one interviewer and audio recorded. Interviews were
transcribed verbatim and a thematic analysis was conducted.
Results:Seventeen semi-structured interviews were conducted (13 male; 4 female). Three main, inter-related themes
emerged (complex prescribing environment, paternalistic doctor-patient relationship, and relevance of PIP concept).
Patient complexity (e.g. polypharmacy, multimorbidity), as well as prescriber complexity (e.g. multiple prescribers, poor
communication, restricted autonomy) were all identified as factors contributing to a complex prescribing environment
where PIP could occur, as was a paternalistic-doctor patient relationship. The concept of PIP was perceived to be of
variable usefulness to GPs and the criteria to measure it may be at odds with the complex processes of prescribing for
this patient population.
Conclusions:Several inter-related factors contributing to the occurrence of PIP were identified, some of which may be
amenable to intervention. Improvement strategies focused on improved management of polypharmacy and
multimorbidity, and communication across primary and secondary care could result in substantial improvements in PIP.
Trial registration:Current controlled trials ISRCTN41694007