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Factors influencing GPs’ choice between drugs in a therapeutic drug group. A qualitative study

Objective. To explore how GPs choose between drugs in a therapeutic drug group. Design. A qualitative study based on semi-structured ethnographic interviews. Setting and subjects. General practitioners from the counties of both Funen and West Zealand in Denmark. A total of 15 general practitioners (GPs) were selected with reference to variation in organizational structure, age, and gender. Main outcome measures. GPs’ description of drug choice in relation to specific patient encounters involving a prescription. Results. All informants appeared to consider drug price important as it was a recurring theme during all interviews. External factors outside the GP's control such as governmental regulation on prescribing and the pharmaceutical industry influenced most GPs. Internal factors related to the actual consultation included characteristics of the GP and the patient, drug characteristics, and repeat prescriptions. These factors interact in a non-linear and unpredictable way similar to complex adaptive systems. Conclusion. GPs balance both internal and external factors when choosing between analogues. Drug choice is a regulated process in the realm of complex prescribing behaviour with drug costs as a major factor.