Worlds apart? An exploration of prescribing and medicine –taking decisions by patients, GPs and local policy makers.

<p>Current healthcare policy in the UK has been shaped by two major forces; increasing accountability to evidence-based standards and increasing patient involvement. Shared decision-making brings the patient into prescribing decisions, and guidelines introduce a third decision-maker, the policy maker, into the doctor–patient consultation. This study explored the decision-making processes used by patients and GPs in comparison to local policy makers.Method: Qualitative interviews with 8GPs, 14 patients and 2 PCT Prescribing Advisers, followed by quantitative questionnaires completed by 305 GPs and 533 patients.Results: Patients made individual medicine-taking decisions based on experience, personal financial and human cost, trust and the relational aspects of their interactions with doc- tors over time. In contrast local implementation of prescribing guidelines was based on consideration of financial costs, efficacy and risks, based on objective clinical evidence at a population level. GPs adopted a mid-position between these two polar views.Guidelines are written from a different perspective to the worldview of patients, and they tend to downplay the criteria most important to patients. This has the potential to have a harmful effect on patients’ medicine-taking and adherence. Paradoxically, enforcing the use of guidelines could inhibit the achievement of guideline targets.</p>