Prescriber use of Medicines Information Service advice in their decision-making and patient care: an exploratory qualitative study
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AbstractPharmacy-led Medicines Information (MI) Services provide evidence-based advice to clinicians, with high levels of user satisfaction. However, satisfaction does not necessarily reflect improved patient care or patient outcome. This has led to MI research concentrating on the effect MI advice has on patients, despite a lack of agreed definitions of effectiveness and the construction of inappropriate outcome measures. Although the majority of prescribing happens in primary care, most MI research has focused on secondary care. The aim of this qualitative study was to better understand how primary care clinicians used MI advice in shaping their prescribing decision-making and subsequent patient care. Taking an interpretive, idealist perspective and using a generic qualitative, exploratory methodological approach, this study tried to understand how prescribers use MI advice in decision-making and patient care. Prescribers (general practitioners and dentists) across England who contacted MI Services with a medicine-related question, were interviewed by telephone. To expand on findings from these interviews, additional prescribers in North West England were interviewed face-to-face. All interviews (n=55) were analysed inductively using constant comparison to identify themes. Key findings of this study were clinicians describing using MI advice as a safety net to shape, support, or do their difficult research and make prescribing decisions, especially for complex or high risk cases. New knowledge was incorporated into their ‘mindlines’ and shared with their ‘community of practice’, for future decision-making. They valued advice provided by a trusted, expert ‘help desk’, which empowered them to make prescribing changes for their patients confidently and safely, and was also quicker than, and avoided, patient referrals. To conclude, this is the first study to describe the direct influence MI advice has on clinician decision-making and prescribing. In light of this work there is a need to revisit currently used definitions describing impact and outcome, with MI services working alongside health library services to achieve this goal. The role of medicines advice giving in prescribing models also needs to be recognised.
PublisherUniversity of Wolverhampton
TypeThesis or dissertation
DescriptionA thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.
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