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The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study

PURPOSE: Non-medical or contextual factors strongly influence physicians’ prescribing behavior and may explain why drugs, such as benzodiazepines and Z-drugs, are still frequently prescribed in spite of well-known adverse effects. This study aimed to explore which contextual factors influence the pr...

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Autores principales: Weiß, Vivien, Nau, Roland, Glaeske, Gerd, Hummers, Eva, Himmel, Wolfgang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326988/
https://www.ncbi.nlm.nih.gov/pubmed/30215101
http://dx.doi.org/10.1007/s00228-018-2555-9
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author Weiß, Vivien
Nau, Roland
Glaeske, Gerd
Hummers, Eva
Himmel, Wolfgang
author_facet Weiß, Vivien
Nau, Roland
Glaeske, Gerd
Hummers, Eva
Himmel, Wolfgang
author_sort Weiß, Vivien
collection PubMed
description PURPOSE: Non-medical or contextual factors strongly influence physicians’ prescribing behavior and may explain why drugs, such as benzodiazepines and Z-drugs, are still frequently prescribed in spite of well-known adverse effects. This study aimed to explore which contextual factors influence the prescription of hypnotics and sedatives and to compare their role in primary and secondary care. METHODS: Understanding medical practices as games with specific rules and strategies and performed in a largely habitual, not fully conscious manner, we asked a maximum variation sample of 12 hospital doctors and 12 general practitioners (GPs) about their use of hypnotics and sedatives. The interviews were analyzed by qualitative content analysis. RESULTS: Hospital doctors’ and GPs’ use of hypnotics and sedatives was influenced by a variety of contextual factors, such as the demand of different patient groups, aims of management, time resources, or the role of nurses and peers. Negotiating patient demands, complying with administrative regulations, and finding acceptable solutions for patients were the main challenges, which characterized the game of drug use in primary care. Maintaining the workflow in the hospital and finding a way to satisfy both nurses and patients were the main challenges in secondary care. CONCLUSIONS: Even if doctors try to act rationally, they cannot escape the interplay of contextual factors such as handling patient needs, complying with administrative regulations, and managing time resources. Doctors should balance these factors as if they were challenges in a complex game and reflect upon their own practices. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00228-018-2555-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-63269882019-01-25 The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study Weiß, Vivien Nau, Roland Glaeske, Gerd Hummers, Eva Himmel, Wolfgang Eur J Clin Pharmacol Pharmacoepidemiology and Prescription PURPOSE: Non-medical or contextual factors strongly influence physicians’ prescribing behavior and may explain why drugs, such as benzodiazepines and Z-drugs, are still frequently prescribed in spite of well-known adverse effects. This study aimed to explore which contextual factors influence the prescription of hypnotics and sedatives and to compare their role in primary and secondary care. METHODS: Understanding medical practices as games with specific rules and strategies and performed in a largely habitual, not fully conscious manner, we asked a maximum variation sample of 12 hospital doctors and 12 general practitioners (GPs) about their use of hypnotics and sedatives. The interviews were analyzed by qualitative content analysis. RESULTS: Hospital doctors’ and GPs’ use of hypnotics and sedatives was influenced by a variety of contextual factors, such as the demand of different patient groups, aims of management, time resources, or the role of nurses and peers. Negotiating patient demands, complying with administrative regulations, and finding acceptable solutions for patients were the main challenges, which characterized the game of drug use in primary care. Maintaining the workflow in the hospital and finding a way to satisfy both nurses and patients were the main challenges in secondary care. CONCLUSIONS: Even if doctors try to act rationally, they cannot escape the interplay of contextual factors such as handling patient needs, complying with administrative regulations, and managing time resources. Doctors should balance these factors as if they were challenges in a complex game and reflect upon their own practices. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00228-018-2555-9) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2018-09-13 2019 /pmc/articles/PMC6326988/ /pubmed/30215101 http://dx.doi.org/10.1007/s00228-018-2555-9 Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Pharmacoepidemiology and Prescription
Weiß, Vivien
Nau, Roland
Glaeske, Gerd
Hummers, Eva
Himmel, Wolfgang
The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study
title The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study
title_full The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study
title_fullStr The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study
title_full_unstemmed The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study
title_short The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study
title_sort interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study
topic Pharmacoepidemiology and Prescription
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326988/
https://www.ncbi.nlm.nih.gov/pubmed/30215101
http://dx.doi.org/10.1007/s00228-018-2555-9
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