The factors affecting the prescribing in family medicine: Patients' expectation and doctors' perception

Introduction and Aim: Clinical decision-making in family medicine is strongly affected by social factors; as well as the expectations of consulting patients. It is accepted that prescription request is one of the significant factors of medication expenses. Aim of this study is to investigate how the doctor's decision on prescription writing is affected by patients' expectations, factors related to the patients' health problem and doctors' perception of such expectations. Materials and Methods: This study consists of 7 family physicians, operating at family health centers in Ankara and volunteered to participate in the study; and 300 patients having consulted these centers. The patients were applied a questionnaire, consisting of 21 questions, to be answered before the examination and completed by the family physician afterwards. By this, socio-demographic features, general health conditions, main purposes of consultation and prescription expectations of the patients were analyzed; as well as doctor's perception of patient expectations, fell of pressure and behavior towards prescribing. IBM SPSS Statistics 21.0 and MS-Excel 2007 were used in the research. During the analysis of the research data, divisions (Figure, %) were used for categorical variables. During the comparisons between the variables; the results of Person chi-square, Yates chi-square, Fisher exact test, McNemar test and uni-variate logistic regression model were analyzed. Statistical significance level was established as p<0.05. Results: 209 (69.7%) female and 91 (30.3%) male patients participated in the study. When the age distribution of the patients were analyzed, it was found that the patients were mostly between the age range of 40-54 by 35.3% (n=106). 85.3% (n=256) of the patients stated that they were in an expectation of a prescription regarding their health problems. Doctors prescribed medication to 82.7% (n=248) of the patients who consulted them. The doctor perceived that 66.4% of the patients, who stated that they expect a prescription, were in such an expectation. 91.4% of the patients with expectation for a prescription were prescribed medication. Doctors also wrote prescription to 97.2% of the patients whom they perceived were in such an expectation. It is also determined that the doctors' feel of pressure might be effective on their decision process of prescription writing. It was also found that the ages, education levels, current health problems, durations, their previous consultations and related anxiety levels of the patients affect their expectations for prescription, perception of the doctor and decision on writing prescription. Conclusion: The study reveals that the expectation of the patient, perception of the doctor and doctor's feel of pressure may strongly affect his/her decision making on writing prescription. In Turkey, expectation level of patients who consult family physicians is high. Precautions on improving the attitude towards prescription writing cover the apprehensions of patients, clarification of their expectations, discussion of treatment options and relation between doctor and patient. For a more effective use of family medicine system, further studies, revealing the mechanism of patient-doctor expectation relation, are needed.