The potential existence of ‘Small Individual Formulary’ in prescribing behaviour: a qualitative semi-structured interview study

There is a widely held but previously unsubstantiated belief that prescribers tend to consider and use a limited set of medications when making prescribing decisions. This study aimed to enhance understanding of the process of prescribing decision making in a real-world context. Using constructivist grounded theory methodology, we conducted semi-structured interviews with 11 healthcare providers in Georgia state. The providers, most of whom are physicians of different specialties, shared their perspectives about prescribing decision making and their perceptions about using a limited set of medications in daily practice. Three themes emerged from the qualitative analysis: (1) prescribers recognized the existence of ‘small individual formularies’ and considered it helpful in simplifying prescribing decision making; (2) healthcare providers employed an algorithm to initiate and step up drug therapy for patients; (3) formulary and patient affordability played a vital role in prescribing. Physicians and other prescribers consider and use a limited set of prescription drugs based on their internal prescribing behaviour algorithm. Strategies could be developed to help stakeholders use this information to improve medication use.