Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/23264
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dc.contributor.authorGrant, Aileenen_UK
dc.contributor.authorSullivan, Frank Men_UK
dc.contributor.authorDowell, Jonen_UK
dc.date.accessioned2016-06-01T23:51:58Z-
dc.date.available2016-06-01T23:51:58Z-
dc.date.issued2013-06-21en_UK
dc.identifier.other72en_UK
dc.identifier.urihttp://hdl.handle.net/1893/23264-
dc.description.abstractBackground  Prescribing is a core activity for general practitioners, yet significant variation in the quality of prescribing has been reported. This suggests there may be room for improvement in the application of the current best research evidence. There has been substantial investment in technologies and interventions to address this issue, but effect sizes so far have been small to moderate. This suggests that prescribing is a decision-making process that is not sufficiently understood. By understanding more about prescribing processes and the implementation of research evidence, variation may more easily be understood and more effective interventions proposed.  Methods  An ethnographic study in three Scottish general practices with diverse organizational characteristics. Practices were ranked by their performance against Audit Scotland prescribing quality indicators, incorporating established best research evidence. Two practices of high prescribing quality and one practice of low prescribing quality were recruited. Participant observation, formal and informal interviews, and a review of practice documentation were employed.  Results  Practices ranked as high prescribing quality consistently made and applied macro and micro prescribing decisions, whereas the low-ranking practice only made micro prescribing decisions. Macro prescribing decisions were collective, policy decisions made considering research evidence in light of the average patient, one disease, condition, or drug. Micro prescribing decisions were made in consultation with the patient considering their views, preferences, circumstances and other conditions (if necessary).  Although micro prescribing can operate independently, the implementation of evidence-based, quality prescribing was attributable to an interdependent relationship. Macro prescribing policy enabled prescribing decisions to be based on scientific evidence and applied consistently where possible. Ultimately, this influenced prescribing decisions that occur at the micro level in consultation with patients.  Conclusion  General practitioners in the higher prescribing quality practices made two different ‘types’ of prescribing decision; macro and micro. Macro prescribing informs micro prescribing and without a macro basis to draw upon the low-ranked practice had no effective mechanism to engage with, reflect on and implement relevant evidence. Practices that recognize these two levels of decision making about prescribing are more likely to be able to implement higher quality evidence.en_UK
dc.language.isoenen_UK
dc.publisherBioMed Centralen_UK
dc.relationGrant A, Sullivan FM & Dowell J (2013) An ethnographic exploration of influences on prescribing in general practice: why is there variation in prescribing practices?. Implementation Science, 8, Art. No.: 72. https://doi.org/10.1186/1748-5908-8-72en_UK
dc.rights© Grant et al.; licensee BioMed Central Ltd. 2013 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.en_UK
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_UK
dc.subjectPrescribingen_UK
dc.subjectQualityen_UK
dc.subjectGeneral practiceen_UK
dc.subjectPrimary careen_UK
dc.subjectEthnographicen_UK
dc.subjectQualitativeen_UK
dc.titleAn ethnographic exploration of influences on prescribing in general practice: why is there variation in prescribing practices?en_UK
dc.typeJournal Articleen_UK
dc.identifier.doi10.1186/1748-5908-8-72en_UK
dc.identifier.pmid23799906en_UK
dc.citation.jtitleImplementation Scienceen_UK
dc.citation.issn1748-5908en_UK
dc.citation.volume8en_UK
dc.citation.publicationstatusPublisheden_UK
dc.citation.peerreviewedRefereeden_UK
dc.type.statusVoR - Version of Recorden_UK
dc.author.emailaileen.grant@stir.ac.uken_UK
dc.citation.date21/06/2013en_UK
dc.contributor.affiliationHealth Sciences Research - Stirling - LEGACYen_UK
dc.contributor.affiliationUniversity of Dundeeen_UK
dc.contributor.affiliationUniversity of Dundeeen_UK
dc.identifier.isiWOS:000320934900001en_UK
dc.identifier.scopusid2-s2.0-84879101892en_UK
dc.identifier.wtid571030en_UK
dc.contributor.orcid0000-0001-6146-101Xen_UK
dc.date.accepted2013-06-14en_UK
dcterms.dateAccepted2013-06-14en_UK
dc.date.filedepositdate2016-06-01en_UK
rioxxterms.typeJournal Article/Reviewen_UK
rioxxterms.versionVoRen_UK
local.rioxx.authorGrant, Aileen|0000-0001-6146-101Xen_UK
local.rioxx.authorSullivan, Frank M|en_UK
local.rioxx.authorDowell, Jon|en_UK
local.rioxx.projectInternal Project|University of Stirling|https://isni.org/isni/0000000122484331en_UK
local.rioxx.freetoreaddate2016-06-01en_UK
local.rioxx.licencehttp://creativecommons.org/licenses/by/4.0/|2016-06-01|en_UK
local.rioxx.filenameGrant_et_al_Implementation_Science_2013.pdfen_UK
local.rioxx.filecount1en_UK
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