Drug prescribing: patterns, problems and proposals

Key factors influencing the prescribing of statins: a qualitative study among physicians working in primary healthcare facilities in Indonesia

OBJECTIVES

To elicit key factors influencing physicians' decision to prescribe statins.

DESIGN

A qualitative study using a phenomenological approach within a pragmatism interpretive framework. A combination of purposive and snowball sampling was used to recruit physicians. Data were collected through face-to-face, semistructured interviews with physicians working in primary healthcare facilities in a capital of a province in Indonesia. We recorded and verbatim transcribed the interviews. Coding was done independently by two researchers and data were analysed using phenomenological data analyses. Key factors influencing physicians' decision to prescribe statins were classified into factors at the microlevels, mesolevels and macrolevels according to the structural model by Scoggins et al. PARTICIPANTS AND SETTING: Physicians working in primary healthcare facilities in a capital of a province in Indonesia.

RESULTS

Ten physicians were included in the study. Key factors at the microlevel were that physicians knew guidelines in general, but there was uncertainty how to take into account the level of total cholesterol in combination with other cardiovascular risk factors such as diabetes and hypertension. At the macrolevel, the new National Health Insurance System (NHIS) that appeared to facilitate the prescription of statins though more clinical information should be integrated in the system's platform to support appropriate prescribing.

CONCLUSIONS

The findings indicate lack of awareness of specific details in current guideline recommendations. Appropriate prescribing of statins should be enhanced using the new NHIS.

[Does self involvement promote self medication? A comparative study of 6 countries of the European community]

Discussing cost-sharing in health care as a means to arrive at certain cost retrenchments is nowadays a popular topic in Switzerland. This also holds true for patient part-payment of medicines, through which the level of reimbursement of prescription medicines by sick-funds may be decreased. This paper reviews recent changes in the patient part-payment system for drugs in 6 countries of the European Community. It is investigated whether the rate of self-medication increases, when patient part-payment systems for drugs are intensified. Especially the English situation seems to prove the validity of this correlation. However, one should be cautious, because many other factors--such as whether a medicine has a prescription-only status or not--may also play a prominent role.