Dataset Information

General practitioners' prescribing behaviour as a determinant of poor persistence with inhaled corticosteroids in children with respiratory symptoms: mixed methods study.

ABSTRACT:

Objectives

To evaluate general practitioners' (GPs') prescribing behaviour as a determinant of persistence with and adherence to inhaled corticosteroids (ICS) in children.

Design

Prospective observational study of persistence with and adherence to ICS followed by a focus group study of the GPs prescribing this treatment.

Setting

7 primary care practices in the area of Zwolle, the Netherlands.

Participants

134 children aged 2-12 years had been prescribed ICS in the year before the study started by their 19 GPs.

Main outcome measures

Patterns and motives of GPs' prescribing behaviour and the relationship with persistence with and adherence to ICS.

Results

GPs' prescribing behaviour was characterised by prescribing short courses of ICS to children with various respiratory symptoms without follow-up for making a diagnosis of asthma. This was driven by the GPs' pragmatic approach to deal with the large number of children with respiratory symptoms, and by beliefs about ICS which differed from currently available evidence. This prescribing behaviour was the main reason why 68 (51%) children did not persist with the use of ICS. In children with persistent use of ICS and a GP's advice to use ICS on a daily basis, the median (IQR) adherence was 70% (41-84%), and was similar for patients with persistent asthma and children lacking a diagnosis or symptoms of asthma.

Conclusions

Inappropriate prescription of ICS to children by GPs is common and drives the lack of persistence with ICS therapy in primary care. This finding should be taken into account when interpreting data from large prescription database studies. Improving primary healthcare providers' knowledge and competence in diagnosing and managing asthma in children is needed.

SUBMITTER: Klok T

PROVIDER: S-EPMC3641491 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Publications

General practitioners' prescribing behaviour as a determinant of poor persistence with inhaled corticosteroids in children with respiratory symptoms: mixed methods study.

Klok Ted T Kaptein Ad A AA Duiverman Eric E Oldenhof Frank S FS Brand Paul L P PL

BMJ open 20130403 4

<h4>Objectives</h4>To evaluate general practitioners' (GPs') prescribing behaviour as a determinant of persistence with and adherence to inhaled corticosteroids (ICS) in children.<h4>Design</h4>Prospective observational study of persistence with and adherence to ICS followed by a focus group study of the GPs prescribing this treatment.<h4>Setting</h4>7 primary care practices in the area of Zwolle, the Netherlands.<h4>Participants</h4>134 children aged 2-12 years had been prescribed ICS in the ye ...[more]

PMID: 23558733

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Project description:BACKGROUND:This study was embedded in the Check-In randomised controlled trial that investigated the effectiveness of general practice-based preventive health checks on adverse health behaviour and early detection of non-communicable diseases offered to individuals with low socioeconomic positions. Despite successful recruitment of patients, the intervention had no effect. One reason for the lack of effectiveness could be low rates of referral to behaviour-change programmes in the municipality, resulting in a low dose of the intervention delivered. The aim of this study is to examine the referral pattern of the general practitioners and potential barriers to referring eligible patients to these behaviour-change programmes. METHODS:A mixed-method design was used, including patients' questionnaires, recording sheet from the health checks and semi-structured qualitative interviews with general practitioners. All data used in the study were collected during the time of the intervention. Logistic regressions were used to estimate odds ratios for being eligible and for receiving referrals. The qualitative empirical material was analysed thematically. Emerging themes were grouped, discussed and the material was re-read. The themes were reviewed alongside the analysis of the quantitative material to refine and discuss the themes. RESULTS:Of the 364 patients, who attended the health check, 165 (45%) were marked as eligible for a referral to behaviour-change programme by their general practitioner and of these, 90 (55%) received referrals. Daily smoking (OR?=?3.22; 95% CI:2.01-5.17), high-risk alcohol consumption (OR?=?2.66; 95% CI:1.38-5.12), obesity (OR?=?2.89; 95% CI:1.61-5.16) and poor lung function (OR?=?2.05; 95% CI:1.14-3.70) were all significantly associated with being eligible, but not with receiving referral. Four themes emerged as the main barriers to referring patients to behaviour-change programmes: 1) general practitioners' responsibility and ownership for their patients, 2) balancing information and accepting a rejection, 3) assessment of the right time for behavioural change and 4) general practitioners' attitudes towards behaviour-change programmes in the municipality. CONCLUSION:We identified important barriers among the general practitioners which influenced whether the patients received referrals to behaviour-change programmes in the municipality and thereby influenced the dose of intervention delivered in Check-In. The findings suggest that an effort is needed to assist the collaboration between general practices and the municipalities' primary preventive services. TRIAL REGISTRATION:Clinical Trials NCT01979107 ; October 25, 2013.

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Dataset Information

General practitioners' prescribing behaviour as a determinant of poor persistence with inhaled corticosteroids in children with respiratory symptoms: mixed methods study.

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

General practitioners' prescribing behaviour as a determinant of poor persistence with inhaled corticosteroids in children with respiratory symptoms: mixed methods study.

Similar Datasets

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