The aim of this paper is to explore general practitioners' (GPs) prescribing intentions and patterns across different European regions using the Theory of Planned Behavior (TPB). A cross-sectional study was undertaken in selected geographically defined Primary Health Care areas in Cyprus, Czech Republic (CZ), France, Greece, Malta, Sweden and Turkey. Face-to-face interviews were conducted using a TPB-based questionnaire. The number of GP participants ranged from 39 to 145 per country. Possible associations between TPB direct measures (attitudes, subjective norms (SN) and perceived behavioral control (PBC)) and intention to prescribe were assessed by country. On average, GPs thought positively of, and claimed to be in control of, prescribing. Correlations between TPB explanatory measures and prescribing intention were weak, with TPB direct measures explaining about 25% of the variance in intention to prescribe in Malta and CZ but only between 3% and 5% in Greece, Sweden and Turkey. SN appeared influential in GPs from Malta; attitude and PBC were statistically significant in GPs from CZ. GPs' prescribing intentions and patterns differed across participating countries, indicating that country-specific interventions are likely to be appropriate. Irrational prescribing behaviors were more apparent in the countries where an integrated primary care system has still not been fully developed and policies promoting the rational use of medicines are lacking. Demand-side measures aimed at modifying GPs prescribing behavior are deemed necessary.

Charles University Prague Faculty of Pharmacy in Hradec Kralove Czech Republic

Clinic of Social and Family Medicine Faculty of Medicine University of Crete P O Box 2208 71003 Greece

Department of Health Economics National School of Public Health 196 Alexandras Avenue 11521 Athens Greece; Clinic of Social and Family Medicine Faculty of Medicine University of Crete P O Box 2208 71003 Greece

Department of Medicine and Health Community Medicine General Practice Faculty of Health Sciences Linkoping University SE 581 83 Linkoping Sweden

Department of Social Medicine Faculty of Medicine University of Crete P O Box 2208 Heraklion 71003 Crete Greece

Mediterranean Institute of Primary Care 19 Triqir Rand Attard Malta

Sorbonne Universités UPMC University Paris 06 INSERM UMR_S 1136 Institute Pierre Louis of Epidemiologie and Public Health Team EPAR F 75013 Paris France; Société Française de Médecine Générale 141 avenue de Verdun 92130 ISSY LES MOULINEAUX France

St George's University of London medical programmedelivered in Cyprus by the University of Nicosia Medical School Cyprus

University of Uludag Faculty of Medicine Department of Family Practice Department of Medical Education Bursa Turkey; Turkish Association of Family Physicians Turkey

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