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Sources of influence on medical practice
  1. Luis Andrés López Fernándeza,
  2. Juan Manuel Jiménez Martína,
  3. Juan de Dios Luna del Castillob,
  4. Olga Solas Gaspara,
  5. Juan Ignacio Martínez Millána,
  6. María José Pérez Lozanoc,
  7. Esteban De Manuel Keenoya
  1. aAndalusian School of Public Health (EASP), Granada, Spain, bDepartment of Biostatistics, Faculty of Medicine, University of Granada, Spain, cAgency for the Assessment of Health Technologies, Seville, Spain
  1. Dr López Fernández, Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja s/n, 18080 Granada, Spain (luisandres{at}


OBJECTIVES To explore the opinion of general practitioners on the importance and legitimacy of sources of influence on medical practice.

METHODS General practitioners (n=723) assigned to Primary Care Teams (PCTs) in two Spanish regions were randomly selected to participate in this study. A self administered questionnaire was sent by mail and collected by hand. The dependent variable collected the opinion on different sources that exert influence on medical practice. Importance was measured with a 9 item scale while legitimacy was evaluated with 16 items measured with a 1 to 7 point Likert scale.

RESULTS The most important and legitimate sources of influence according to general practitioners were: training courses and scientific articles, designing self developed protocols and discussing with colleagues. The worst evaluated were: financial incentives and the role played by the pharmaceutical industry.

CONCLUSIONS The development of medical practice is determined by many factors, grouped around three big areas: organisational setting, professional system and social setting. The medical professional system is the one considered as being the most important and legitimate by general practitioners. Other strategies of influence, considered to be very important by the predominant management culture (financial incentives), are not considered to be so by general practitioners. These results, however, are not completely reliable as regards the real network of influences existing in medical practice, which reflect instead different “value systems”.

  • primary health care
  • physicians' practice patterns
  • medical practice management
  • physicians' incentive plans

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  • Funding: research financed by the Spanish Fund for Medical Research (Fondo de Investigaciones Sanitarias (FIS), Spanish Ministry of Health, file no 93/0530) and by the Andalusian Department for Health (Consejería de Salud) of the Andalusian Regional Government.

  • Conflicts of interest: none.