Background
The use of psychotropics is increasing both internationally and in Sweden, and the majority of these drugs are prescribed in primary care. The drug group psychotropics include antidepressants, anxiolytics/hypnotics, mood stabilizers, and antipsychotics, which are all used to treat psychiatric disorders. While the use of psychotropics confers many benefits and is sometimes life-saving, it is also associated with problems of dependency, medicalization and side-effects. Elderly people are particularly sensitive to side-effects, and the risk increases with the number of drugs used. In fact, withdrawal of psychotropics among these patients has been reported to improve cognition and to reduce the incidence of falls. In the Region Västra Götaland in western Sweden, the prescribing of psychotropics is extensive compared to other parts of the country. In this region, a high proportion of elderly people also use three or more psychotropics concurrently, a measure considered an indicator of problematic prescribing.
For these reasons, there may be a need for interventions aimed at limiting prescriptions of psychotropics to patients who do not clearly benefit from these drugs. Arguably, as polypharmacy may be a problem in itself, such interventions should target the prescribing of psychotropics in general, rather than that of specific drug groups. Consequently, knowledge is needed about factors that can influence the prescribing of this drug group as a whole.
Previous qualitative studies, however, have only investigated physician decision making concerning specific psychotropic drug groups, such as hypnotics, antidepressants, and anxiolytics. One quantitative study set out to establish if there was an association between physician characteristics (e.g. physician age or practice size) and prescribing of psychotropic medication, but the authors concluded that this particular prescribing is hard to predict. Further, previous research has mostly been focused on the initiation of psychotropic drugs. There appears to be a lack of a comprehensive analysis of factors affecting all prescribing of psychotropics in primary care, that is, both initiation and maintenance of prescriptions. Therefore, the aim of this study was to explore the views of general practitioners (GPs), GP interns, and heads of primary care units on factors affecting the prescribing of psychotropic drugs in general in primary care.