Research article

Family Physician attitudes about prescribing using a drug formulary

L Suzanne Suggs¹ , Parminder Raina^2,3 , Amiram Gafni² , Susan Grant⁴ , Kevin Skilton⁴ , Aimei Fan⁵ and Karen Szala-Meneok⁶

¹Institute of Communication and Health, Facultyof Communication Sciences, University of Lugano, Switzerland

²Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

³Evidence-based Practice Center, McMaster University, Hamilton, Ontario, Canada

⁴Merck Frosst Canada, Kirkland, Quebec, Canada

⁵Public Health Services, City of Hamilton, Hamilton, Ontario, Canada

⁶School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada

author email corresponding author email

BMC Family Practice 2009, 10:69doi:10.1186/1471-2296-10-69

Published:	16 October 2009

Abstract

Background

Drug formularies have been created by third party payers to control prescription drug usage and manage costs. Physicians try to provide the best care for their patients. This research examines family physicians' attitudes regarding prescription reimbursement criteria, prescribing and advocacy for patients experiencing reimbursement barriers.

Methods

Focus groups were used to collect qualitative data on family physicians' prescribing decisions related to drug reimbursement guidelines. Forty-eight family physicians from four Ontario cities participated. Ethics approval for this study was received from the Hamilton Health Sciences/Faculty of Health Sciences Research Ethics Board at McMaster University. Four clinical scenarios were used to situate and initiate focus group discussions about prescribing decisions. Open-ended questions were used to probe physicians' experiences and attitudes and responses were audio recorded. NVivo software was used to assist in data analysis.

Results

Most physicians reported that drug reimbursement guidelines complicated their prescribing process and can require lengthy interpretation and advocacy for patients who require medication that is subject to reimbursement restrictions.

Conclusion

Physicians do not generally see their role as being cost-containment monitors and observed that cumbersome reimbursement guidelines influence medication choice beyond the clinical needs of the patient, and produce unequal access to medication. They observed that frustration, discouragement, fatigue, and lack of appreciation can often contribute to family physicians' failure to advocate more for patients. Physicians argue cumbersome reimbursement regulations contribute to lower quality care and misuse of physicians' time increasing overall health care costs by adding unnecessary visits to family physicians, specialists, and emergency rooms.