Drug expectations and drug choices of hospital physicians

Abstract

Objectives: To assess whether differences in drug choices of hospital physicians are related to differences in the underlying decision-making process.

Design: A survey study was conducted addressing drug choices in six therapeutic fields with existing interprescriber variations; prescribers and non-prescribers of drugs of which the merits were not sufficiently proven (i.e. the 'target drugs') were compared.

Setting: A 1000-bed university hospital in The Netherlands.

Subjects: All 85 hospital physicians working in specialities involving one of the selected fields were asked to participate; 72 physicians completed the interviews.

Main outcome measures: Comparisons were made regarding three elements of the decision-making process: (1) the physicians' expectations of the target drugs and frequently used alternatives, (2) the weights attached to the principal treatment aspects, and (3) the extent to which their actual choice is based on these expectations and weights.

Results: In three fields, i.e. anti-emetics, vasodilators, and platelet inhibitors, the prescribers of the less desirable target drugs had higher expectations of these drugs in comparison to the non-prescribers. In the other therapeutic fields, choosing target drugs was related either to attaching less importance to side-effects and costs, or to attaching less importance to reports from clinical trials. Twenty of the 46 treatment choices of the prescribers of target drugs could not be predicted from their expressed views as opposed to 5 of the 36 choices of the non-prescribers (P < 0.05).

Conclusions: Choosing less desirable drugs is not always related to having too high expectations of the drug. Assigning a different importance to certain aspects of the drug and resorting to decision strategies that do not include the weighing of all pros and cons provide alternative explanations for such treatment choices.