Prescribing variation across Europe: Insights into prescribing practices and educational needs

AIMS: Prescribing medication is a complex process, influenced by many factors that can be weighed differently. Four prescriber profiles have been identified: pragmatic-contextual, guideline-oriented, experience-driven and vulnerability-focused. However, the extent to which European prescribers identify with these profiles and the role of these profiles in clinical pharmacology and therapeutics (CPT) education is unclear. Knowledge of this might improve prescribing education and thereby prescribing practice.

METHODS: A cross-sectional survey was conducted among physicians, physician assistants, advanced nurse practitioners and prescribing pharmacists across Europe. Participants ranked how strongly they identified with the four prescriber profiles, whether they recognized them in fellow healthcare professionals and whether these were covered in CPT education.

RESULTS: A total of 170 prescribers from 23 European countries and over 40 different medical disciplines participated in this study. Most participants identified themselves as being pragmatic-contextual (36.5%) or guideline-oriented (42.9%) prescribers, whereas few considered themselves experience-driven (11.2%) or vulnerability-focused (9.4%) prescribers. Pragmatic-contextual and guideline-oriented prescribing were covered in current CPT education, whereas vulnerability-focused prescribing was poorly covered in current education. Participants thought that future CPT education should include these prescriber profiles.

CONCLUSIONS: These findings highlight the influence of professional background, clinical setting and experience on prescribing approaches across Europe. The strong presence of pragmatic-contextual and guideline-oriented profiles in both practice and education is consistent with current CPT curricula. However, experience-based and vulnerability-focused profiles, though regularly seen in practice, are under-represented in education despite their acknowledged importance. To support the development of prescribing practice, educational strategies should include all profiles.