2.1 Data analysis
The focus groups were audio-recorded and verbatim transcripts underwent
thematic analysis by the authors based upon a pragmatic process where
components of experiences were pieced together to form a picture of
collective experience of the participants, based upon a method described
by Aronson15. Coding of the transcripts was initially
completed independently and finalised after meetings. The subthemes
derived from analysis were matched, where appropriate, to a proposed new
model of physician prescribing decisions published by Murshid and
Mohaidin4.
The initial coding of transcripts followed by aggregation into thematic
dimensions and subthemes was informed by our philosophical approach. The
study was originally conceived as a descriptive quantitative survey and
the focus groups that followed were intended as a means to critique the
appropriateness of prescribing decisions as audited against quantitative
data derived from the first phase of the study. However, it became
apparent, after transcription of the three focus groups, that there was
greater potential to apply interpretivism in our approach to analysis.
We realised that there were further insights to be gained by
comprehending the thought processes that provide context and foundation
to prescribing decisions. Philosophically, our approach therefore
evolved more into alignment with verstehen , a term that was
originally introduced by Max Weber 16 which
essentially refers to an understanding of the world as others see it. It
is recognised that the term ‘interpretivism’ embraces a variety of
different philosophical approaches.17 This study
essentially involves human interpretation and we believe that it may be
more accurately defined as one that is phenomenologically orientated.
Thus, we sought to understand what it is like to be a prescriber and
pharmacist on the AMU (their ‘lived experience’) and to appreciate the
conscientiousness of prescribers and prescribing advisors as they embark
upon making prescribing decisions. It is important to acknowledge that
the medical and pharmacological information that was presented within
the case studies, to provide context for participants, was not relevant
to this phenomenological analysis because there was no intention to pass
judgement over the choice of medicines or to question the
appropriateness of decisions. Thus, we felt that it was important to
disassociate, from the analysis, clinical details relating to care of
patients. For these reasons, the case studies are not included in this
paper.
FINDINGS AND DISCUSSION
The findings highlighted some well-known driving forces that influence
prescribing decisions. These include ‘patient characteristics’, ‘drug
characteristics’, ‘drug characteristics, ‘pharmacist factors’ and
‘trustworthiness’. Interestingly, the influence of ‘marketing effects’
by the pharmaceutical industry, a variable derived from persuasion
theory 4 that has been advocated as a main driver for
prescribing decisions in connection with, for example, brands of drug,
was not overtly observed in the present study. The reason for this
finding is unknown but we postulate that, while complacency must be
avoided, there may today be a greater awareness of potential conflict in
interest that can arise between pharmaceutical representatives and
hospital prescribers.18 The findings uncovered three
new attitudinal factors that influence prescribing decisions that have
not, to date, been described in the literature:1. Reliability of
medication history, 2. Competing pressures and priorities and 3.
Perceived responsibilities of prescribers. A summary of dimensions and
subthemes identified within the findings and presented in relation to
existing prescribing theory and models is shown in Table 1.