Why do GPs continue inappropriate hospital prescriptions of proton pump inhibitors? A qualitative study

Abstract

Background: Inappropriate prescriptions of Proton pump inhibitors (PPIs) initiated in hospitals are frequently continued in primary care. No research has explored why general practitioners (GPs) continue or discontinue inappropriate drug therapy. Objectives: This study aims to describe factors and motives associated with the continuation of inappropriate prescriptions of PPIs in primary care. Methods: Semi-structured qualitative interviews on basis of a purposive sampling of five GPs who often continued inappropriate prescriptions and five GPs who frequently discontinued inappropriate drug therapy with PPIs (10 GPs total, of which four were female and six male). Results: Although all GPs enrolled in the study were enthusiastic about the effectiveness of PPIs, differences between the continuing and discontinuing GPs exists in three areas: The two groups varied (1) in awareness of indications and general attitudes towards prescribing (2) in perception of the hospital physicians' competence in prescribing and (3) appreciation of general prescribing conditions in hospitals. Conclusion: Differences between the continuing and discontinuing GPs were found in their level of knowledge and their perceptions of the hospital physicians' competence and the threshold to prescribing in hospitals. Financial pressure and possible adverse effects demand a more balanced and evidence-based prescribing of PPIs. Attempts to change behaviour should focus on the GPs 'awareness of indications for PPIs, NSAID risks, and prescribing approaches in hospitals. Default prescribing in hospital demands critical examination.