Patient variables associated with expectations for prescriptions and general practitioners' prescribing behaviour: an observational study.

OBJECTIVES: To determine patients' needs and expectations for prescriptions as a function of demographic and illness-associated variables versus outcome of consultation.
DESIGN: Questionnaire study consisting of patient interview before and after consultation with general practitioner.
SETTING: A total of 618 consecutive patients in the waiting room of nine general practices in Germany (Hesse). MAIN OUTCOME MEASURES: Patient needs and expectations for prescriptions and agreement between expected outcome and prescriptions received.
RESULTS: As their top priority for consultation (33% of group), patients expected to receive information about their illness. Their needs for prescriptions (26%) and expectations of receiving them (41%) were clearly lower than physician prescribing (56%). Marked interpatient differences emerged with regard to need/expectation for medication according to age, minor versus chronic illness, duration of treatment, and first-time attendance, but this was not reflected in how often physicians prescribed. A total of 85% of patients expecting a prescription received one; 44% not expressing a need for medication were issued one. Although only 4% of patients would want a drug with questionable effectiveness, doctors wrote such prescriptions to no less than 21% of patients--and especially to those with minor, newly arisen ailments (33%). Nevertheless, patient satisfaction with their visit was very high (98%).
CONCLUSIONS: In Germany, patient needs and expectations for medication are clearly lower than prescribing tendencies, and marked differences between patient groups in their needs or expectations for prescriptions are not reflected in the rates of prescriptions received. Above all, patients with minor illnesses wish to receive information about their illness, and they do not expect prescriptions of drugs with questionable effectiveness.