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Capturing prescribers' minds

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The prescription plays a key role in the provision of healthcare, culminating many consultations, affecting patient well-being and committing expenditure of around 13% of the NHS budget. Ultimately, the contents of the prescription depend on the prescriber's knowledge, attitudes and beliefs, and there are many who would wish to influence these. The eighth annual Drug and Therapeutics Bulletin symposium, 'Capturing prescribers' minds', looked at ways of influencing prescriber's decisions. Here, we summarise the key points raised in the presentations and in subsequent discussion.

Influences on prescriber practice

(Petra Denig). Both internal and external factors influence prescribing decisions. Internal factors include the prescriber's knowledge, values and experiences. External factors, emanating from patients, colleagues, professional groups, academia, government and the pharmaceutical industry, include education, information, demands, incentives, restrictions and regulations. These factors are then integrated into the prescriber's decision-making strategy, which may be categorised as: rational, so based on knowledge and values; pragmatic, on routines and habit; emotional, on values and attitudes; and intuitive, on experience. Attempts to alter prescribing practice need to take into account the relationship between the internal and external factors and prescribers' strategies.

Theories of information transfer

(Cees van der Vleuten). Few facts are learned unless information is presented in ways that enhance retention. To aid its transfer and storage, new information should be: linked to what the learner already knows; presented in context (so allowing storage along with the old information and facilitating retrieval); and acquired actively by the learner, as occurs, for example, through answering questions or resolving problems. Problem-based learning incorporates these principles and is being used increasingly in medical education.

The psychosocial processes of prescriber change

(David Armstrong). Some of the most effective ways of altering behaviour are coercion, reward, and persuasion by 'experts'. However, these have relatively little influence in prescribing. Coercion has generally failed to affect prescribing …

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