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General practitioners’ risk literacy and real-world prescribing of potentially hazardous drugs: a cross-sectional study
  1. Odette Wegwarth1,2,
  2. Tammy C Hoffmann3,
  3. Ben Goldacre4,
  4. Claudia Spies5,
  5. Helge A Giese1
  1. 1Heisenberg Chair for Medical Risk Literacy & Evidence-Based Decisions, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Germany
  2. 2Adpative Rationality, Max-Planck-Institute for Human Development, Berlin, Germany
  3. 3Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
  4. 4Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  5. 5Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Berlin, Germany
  1. Correspondence to Dr Odette Wegwarth, Heisenberg Chair for Medical Risk Literacy & Evidence-Based Decisions, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, 10117, Germany; odette.wegwarth{at}charite.de

Abstract

Background Overuse of medical care is a pervasive problem. Studies using hypothetical scenarios suggest that physicians’ risk literacy influences medical decisions; real-world correlations, however, are lacking. We sought to determine the association between physicians’ risk literacy and their real-world prescriptions of potentially hazardous drugs, accounting for conflicts of interest and perceptions of benefit–harm ratios in low-value prescribing scenarios.

Setting and sample Cross-sectional study—conducted online between June and October 2023 via field panels of Sermo (Hamburg, Germany)—with a convenience sample of 304 English general practitioners (GPs).

Methods GPs’ survey responses on their treatment-related risk literacy, conflicts of interest and perceptions of the benefit–harm ratio in low-value prescribing scenarios were matched to their UK National Health Service records of prescribing volumes for antibiotics, opioids, gabapentin and benzodiazepines and analysed for differences.

Results 204 GPs (67.1%) worked in practices with ≥6 practising GPs and 226 (76.0%) reported 10–39 years of experience. Compared with GPs demonstrating low risk literacy, GPs with high literacy prescribed fewer opioids (mean (M): 60.60 vs 43.88 prescribed volumes/1000 patients/6 months, p=0.016), less gabapentin (M: 23.84 vs 18.34 prescribed volumes/1000 patients/6 months, p=0.023), and fewer benzodiazepines (M: 17.23 vs 13.58 prescribed volumes/1000 patients/6 months, p=0.037), but comparable volumes of antibiotics (M: 48.84 vs 40.61 prescribed volumes/1000 patients/6 months, p=0.076). High-risk literacy was associated with lower conflicts of interest (ϕ = 0.12, p=0.031) and higher perception of harms outweighing benefits in low-value prescribing scenarios (p=0.007). Conflicts of interest and benefit–harm perceptions were not independently associated with prescribing behaviour (all ps >0.05).

Conclusions and relevance The observed association between GPs with higher risk literacy and the prescription of fewer hazardous drugs suggests the importance of risk literacy in enhancing patient safety and quality of care.

  • Evidence-based medicine
  • Decision making
  • Healthcare quality improvement
  • Medical education
  • Patient safety

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request for replication or addition to a meta-analysis research project and only in accordance with the terms of ethics approval. The deidentified dataset is available from the corresponding author.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request for replication or addition to a meta-analysis research project and only in accordance with the terms of ethics approval. The deidentified dataset is available from the corresponding author.

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Footnotes

  • Contributors Concept and design: OW; acquisition, analysis, or interpretation of data: OW, TCH, BG, CS, HAG; drafting of the manuscript: OW; critical revisions of the manuscript for important intellectual content: OW, TCH, BG, CS, HAG; statistical analysis: OW, HAG; obtained funding: OW; administrative, technical, or material support: OW, CS; supervision: OW, TCH, BG. OW is the guarantor for this manuscript.

  • Funding This study was funded by Deutsche Forschungsgemeinschaft (89726186).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.