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Simple linear accounts of prescribing do not adequately address reasons “why” doctors prescribe psychotropic medication to people with intellectual disability (ID). Greater understanding of the complex array of factors that influence decisions to prescribe is needed.

After consideration of a number of conceptual frameworks that have potential to better understand prescribing of psychotropic medication to adults with ID, an ecological model of prescribing was developed. A case study is used to outline how the model can provide greater understanding of prescribing processes.

The model presented aims to consider the complexity and multi-dimensional nature of community-based psychotropic prescribing to adults with ID. The utility of the model is illustrated through a consideration of the case study.

The model presented is conceptual and is as yet untested.

The model presented aims to capture the complexity and multi-dimensional nature of community-based psychotropic prescribing to adults with ID. The model may provide utility for clinicians and researchers as they seek clarification of prescribing decisions.

The paper adds valuable insight into factors influencing psychotropic prescribing to adults with ID. The ecological model of prescribing extends traditional analysis that focuses on patient characteristics and introduces multi-level perspectives that may provide utility for clinicians and researchers.

Aims to measure the appropriateness of the prescribing of benzodiazepines and the effect of intervention strategies designed to improve the appropriate use of benzodiazepines. Cross‐sectional data of appropriate prescribing of benzodiazepines were assessed before and after one of three intervention strategies. Appropriateness of prescribing was assessed using an algorithm based on published evidence. Hospitals were randomly allocated to receive verbal (oral communication), bulletin (paper communication) or control feedback (no communication). The change in rate of appropriate prescribing of benzodiazepines was compared between intervention groups. Gives results and concludes by highlighting areas which can be addressed to increase the impact of intervention in future studies.

Background: Many audits in primary care can be criticized because of the absence of verifiable data to measure outcomes, and the lack of a non‐participating group against which to compare results. Objective: Using Prescribing Analyses and Cost (PACT) data to quantify the effect of an audit in 15 practices. We sought to quantify the effect of the audit of benzodiazepine prescribing in a district by measuring the detailed changes in prescribing in participating practices before, during and after audit, and by comparing the volume of prescribing of these drugs in participating and neighbouring non‐participating practices. Methods: At the start of the audit, 291 993 patients in the Sefton district of North West England were registered with 55 general practices. Fifteen practices, caring for 87 902 patients, took part in an audit of benzodiazepine prescribing. We analysed routinely‐collected prescribing data to assess trends in benzodiazepine prescribing for those practices which took part in the audit and the remaining (non‐participatory) practices in the district. Main measures: The number of defined daily doses of benzodiazepine prescribed by those general practitioners auditing their prescribing of these drugs during the audit. The volume of benzodiazepines prescribed by all general practitioners in Sefton during the quarter immediately before and the quarter immediately after the audit. Results: There was a significant reduction in the number of defined daily doses dispensed for temazepam, nitrazepam, and lorazepam during the audit. There was a significantly greater reduction in the number of items prescribed by those doctors who took part in the audit than their colleagues who did not. Conclusions: An audit of benzodiazepine prescribing achieved a significant reduction in the volume of these drugs dispensed. An analysis of routinely‐collected data can usefully measure the result of an audit of prescribing.

A study was carried out to determine the nature of medical prescribing errors identified by pharmacists in an NHS Hospital Trust. From the 587 errors detected in a one‐month period, eight were potentially grave, 151 were potentially very serious, 351 were potentially moderately serious and 77 were comparatively minor. This extrapolated to 7,044 prescribing problems a year and an estimated detected prescribing error rate of approximately 0.35 to 0.7 per cent. Pharmacists detected 63 per cent of these errors while working on wards and 36 per cent while in dispensaries. The main causes of errors were failure to obtain an accurate medication history, oversight and prescribing uncertainty. In the absence of guidelines, there was a tendency for the isolated hard‐pressed prescriber to guess or prescribe on a “that looks about right somehow” basis. This study has made medical staff more aware of the areas where they are most vulnerable to making prescribing errors. In addition, greater support is now being offered to junior doctors in checking medication histories and in creating prescribing guidelines.

Monthly prescribing behaviour is assessed over a 3‐year period, 1 April 1992 to 31 March 1995. Total monthly number of items prescribed and overall net ingredient cost are analysed for 263 general practices, serving the 1 million residents of Birmingham, UK. Patients aged over 65 years play an important role in elevated prescribing activity. Practice composition varies considerably between training and non‐training practices, and between fundholding and non‐fundholding practices. Accounting for these differences, fundholders expend less and prescribe fewer items than their non‐fundholding counterparts. This is observed against a steady increase in prescribing activity over the study period. There are, however, marked downward shifts in both the number of items prescribed and overall monthly expenditure occurring with every new wave of fundholding. The magnitude of these changes raises doubts about the efficacy of the transition to fundholding and the impact of such large changes upon patient care.

The U.S. healthcare system is very complex and inundated with many challenges, ranging from escalating healthcare expenditure to increasing prevalence of medication errors. Emphasis on cost reduction and prevention of medication errors has given impetus to the development of computerized information technologies. Advanced technological innovation such as e-prescribing has the potential to improve quality of care, reduce costs and enhance patient satisfaction. Reaping these benefits is dependent on successful diffusion of innovation. This chapter summarizes the current literature covering diffusion of e-prescribing technology with an emphasis on the barriers and facilitators, and strategies to overcome these potential barriers.

Prison settings have limited resources, and it is of particular interest to analyze which antipsychotics are commonly prescribed in these conditions and to determine the prevalence of the adverse effects.

A cross-sectional, epidemiological survey was used to measure the prevalence of antipsychotic prescribing among adult prisoners in Sremska Mitrovica Prison in 2020.

The prevalence of antipsychotic use was 7.58%. The most commonly prescribed antipsychotic was clozapine (45.36%), but also olanzapine, haloperidol and risperidone were prescribed. The incidence of extrapyramidal adverse effects was nonexistent and the metabolic parameters did not differ between participants using metabolic syndrome–inducing antipsychotics and those who were prescribed metabolically inert medications. The prescribed doses were lower compared with the recommended.

This research includes certain points that should be cautiously considered. First, the data were cross-sectional and the findings did not provide causal interpretations. Second, the data are from a single penitentiary institution, albeit the largest in the country; however, that may affect the generalizability of the findings. Third, because the included subjects were not hospitalized, some laboratory analyses were not available, according to the local regulations, and thus the prevalence of metabolic syndrome could not be precisely determined.

The prevalence of the antipsychotic use in prison environment is significantly higher than in general population. The most frequently prescribed antipsychotics are clozapine and olanzapine. The prevalence of adverse effects is rare, however, that is possibly due to low doses of the prescribed antipsychotics. The list of therapeutic options available to the incarcerated persons in this facility is also limited. The list of available antipsychotics does not include some atypical antipsychotics with more favorable safety and tolerability profile, such as aripiprazole or cariprazine. Long-acting antipsychotic injectables were also not available to these patients. Laboratory analyses are not regularly conducted and do not include some essential parameters such as lipid status or differential blood count. Low-dose antipsychotics for behavioral symptoms appears to be well tolerated under prison conditions where adherence is assured. It is effective during the prison stay but long-term effects, especially after release from prison, had not been studied.

This paper advocates for better quality of health care in this correctional facility: more therapeutic options and better laboratory monitoring. The authors justify the use of clozapine in this settings due its benefits in reducing violence and aggression; however, further research would be necessary to clarify does the use of clozapine in incarcerated persons cause behavioral improvements that could result in shorter incarcerations, less recidivism and better quality of life.

To the best of the authors’ knowledge, this is the first insight of the antipsychotic prescribing practice in Serbia. There is very limited data on prisoners’ health care, especially mental health care, in Balkan countries. The antipsychotic prescribing pattern in this sample is characterized with higher than expected clozapine use, but without expected adverse effects.

Although there is evidence that the efforts of pharmaceutical marketing exert a positive and significant influence on physician prescription decisions, the specific mechanisms by which this impact occurs remain uncertain. To address this issue, this study aims to investigate whether the physician’s habit persistence may explain the relationship between marketing efforts such as brand attributes and drug promotion and prescribing behavior. This study also explores whether there was any significant difference between specialists and general practitioners (GPs) regarding the effect of brand attributes and drug promotion on physician’s habit persistence, which influences prescribing behavior.

A survey instrument was administered to physicians, encompassing specialists in a particular field and GPs who provide primary care services. A nonparametric partial least squares multigroup analysis was used to analyze 393 valid responses using partial least squares-structural equation modeling.

The results indicate that the decision to prescribe the drug may be affected by the physician’s habit persistence in the presence of vital brand attributes and drug promotion. The relationship between physician’s habit persistence and prescribing behavior is significant in GPs and specialist groups. The findings also reveal that brand attributes are the most influential and significant determinant of physician’s habit persistence in the GPs group. In addition, physician specialists are more aware of the influence of drug promotion initiatives than GPs. Furthermore, this study discovered that the relationship between drug promotion and physician’s habit persistence indicates a significant difference between specialists and GPs.

Although several marketing scholars discuss the factors influencing prescribing behavior, a few studies have shown the role of brand attributes and drug promotion and their effect on physician’s habit persistence. This study will specifically contribute by examining the mediating role of physician’s habit persistence between marketing efforts and prescribing behavior. In addition, so far, no studies have effectively made a comparative analysis across physicians regarding the effect of marketing efforts on physician’s habit persistence and prescribing behavior.

The purpose of this paper is to develop a scale for the measurement of service quality at the manufacturer–doctor interface of the pharmaceutical supply chain and to study the impact of service quality on doctor’s satisfaction and doctor’s prescribing behavior. Doctors from two major states of South India were selected for the study. A doctor perceived service quality scale with three dimensions having eight items was developed through confirmatory factor analysis (CFA) in the pharmaceutical context. Structural equation modeling (SEM) technique was used to show the relationship between service quality, satisfaction and prescribing behavior. The critical factors of service quality were identified, and a model was developed showing the relationship between service quality, doctor’s satisfaction and doctor’s prescribing behavior which has not been explored in any research. This model will be helpful in further development of new concepts and for analyzing the reasons for the failure of doctors in providing quality service. 

A total of 200 doctors from three major cities of South India were selected. A doctor perceived service quality scale with three dimensions having eight items was developed through CFA using Parasuraman Service quality scale (Parasuraman, 1985, 1986, 1988) as the basis in the pharmaceutical context after focus group discussions with company experts, retailers, doctors and academicians. SEM technique was used to examine the impact of service quality on doctor’s satisfaction and prescribing behavior.

There is no universal set of dimensions and items that determine service quality in manufacturing industries, especially at the manufacturer–doctor interface of the pharmaceutical supply chain though service quality plays a very important role in affecting the performance of manufacturing industries. The critical factors affecting the quality of service for a pharmaceutical company at the manufacturer–doctor interface of the supply chain were identified, and its impact on doctor’s satisfaction and their prescribing behavior were studied.

This research contributes to the development of service quality scale for measuring service quality in pharmaceutical manufacturing company, especially with reference to manufacturer–doctor interface of the supply chain which was not thoroughly explored earlier. A model was developed showing the positive relationship between service quality and doctor’s satisfaction and doctor’s prescribing behavior in pharmaceutical supply chain which is a new concept not proved experimentally.

The study is very useful for the pharmaceutical manufacturing companies to identify the service quality factors affecting doctor’s satisfaction and their prescribing behavior thereby leading to development of new measures for improving the performance of the pharmaceutical supply chain. This study can lead to identification of problems involved in pharmaceutical supply chain and also leads to generation of new ideas and development of new concepts for influencing doctor’s satisfaction and doctor’s prescribing behavior which in turn can help in providing better health.

This study actually has a direct impact on the society. If factors affecting doctor’s satisfaction and prescribing behavior are identified automatically, the end consumer, i.e. patient, can be satisfied in a better way, and better medical care can be provided. If doctor’s problems are identified, then better solutions can be provided to patients; this in turn has a lot of positive impact on the pharmaceutical company and society in general.

This research will act as a base for generating ideas relating to how quality service provided by a company will have an impact on doctor’s satisfaction and his prescribing behavior in pharmaceutical supply chain .To the best of the authors’ knowledge, this study is the first of its kind of the conceptual aspects of service quality, satisfaction and loyalty explained in terms of pharmaceutical supply chain as service quality, doctor’s satisfaction and doctor’s prescribing behavior and proved experimentally.

This qualitative study aims to examine key stakeholders' perspectives of primary care group/trust prescribing strategies. Within the context of general practice prescribing, the paper also debates the wider issue of whether GPs' prescribing autonomy is under threat from managerial expansion following recent organisational changes in primary care.

Data were obtained from focus groups and a series of individual semi‐structured interviews with GPs and key primary care organisation stakeholders.

The data underlie a tension between the managerial objective of cost‐restraint and GPs' commitment to quality improvement and individual clinical patient management. In presenting both managerial and medical narratives, two divergent and often conflicting discourses emerge, which leads to speculation that managerial attempts to constrain prescribing autonomy will achieve only limited success. The contention is that GPs' discourse features as a challenge to a managerial discourse that reflects attempts to regulate, standardise and curtail clinical discretion. This is due not only to GPs' expressed hegemonic ideals that clinical practice centres on the interests of the individual patient, but also to the fact that the managerial discourse of evidence‐based medicine encapsulates only a limited share of the knowledge that GPs draw on in decision making. However, while managers' discourse presented them as unwilling to impose change or directly challenge clinical practice, evidence also emerged to suggest that is not yet possible to be sufficiently convinced of the future retention of prescribing autonomy. On the other hand, the use of peer scrutiny posed an indirect managerial influence on prescribing, whilst the emergence of prescribing advisors as analysts of cost‐effectiveness may threaten doctors' dominance of medical knowledge.

There is a continuing need to analyse the impact of the new managerial reforms on primary care prescribing.

This study provides a snapshot of managerial and GP relations at a time of primary care transition.