Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England

Background: Drug-misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug-misuse in electronic patient records (EPRs) however, although the recording trends are similar to national surveys, recording rates are much lower. Aim: To explore the factors that influence GPs to record drug-misuse in EPRs and to gain a clearer understanding of the gap in recording drug-misuse in primary care compared with national surveys and other studies. Design and setting: A qualitative interview study of GPs working in general practices across England. Method: Purposive sampling was employed to recruit 12 GPs both with and without a special interest in drug-misuse from across England. Semi-structured face-to-face interviews were conducted to explore the factors leading to GPs to record drug-misuse. Resulting data were analysed using a combination of inductive and deductive thematic analysis. Results: The complexity of asking about drug-misuse preceded GPs’ decision to record. They described how the following factors influenced if they would firstly ask; the location and size of the general practice, financial incentives of recording, GP experience and training and the interaction between GP and patient. This led to GPs making a clinical decision on if, who and how to record drug-misuse in EPRs. Conclusion: A confluence of factors affect both how GPs acquire information about drug-misuse and the management and treatment which influence various pathways that can lead to GPs recording drug-misuse. When making decisions about whether or not to record drug-misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked, their Clinical Commissioning Group as well as government policies.