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Objective: To investigate specialists' influence on prescribing by general practitioners., Method: A focus group study of 35 GPs., Setting: Hunter Urban Division of General Practice, New South Wales., Results: Although GPs thought specialists had only a small influence on their prescribing overall, it was substantial in some clinical areas, in complex conditions and conditions seen infrequently. Specialists were seen as authoritative and unbiased. Local specialists were particularly influential. Specialist influence came from seeing how specialists managed patients, clinical meetings, and specific verbal advice. It influenced the prescribing of new drugs, selection of drugs within a class and sometimes changed established prescribing practices., Discussion: Interventions to change GPs' prescribing practices should address the importance of specialist influence, and not focus on GPs alone.

Objective: To investigate use of interventions to minimise need for perioperative transfusion of allogeneic blood in surgical units in Australia., Design: Two questionnaire-based surveys of practice., Setting: All hospitals in Australia, 1996-1997., Participants: Survey 1: all Australian hospitals that have at least 50 beds and undertake surgery; Survey 2: surgical units identified as using the interventions., Main Outcome Measures: Reported rates of use of the various interventions (preoperative autologous donation, acute normovolaemic haemodilution [ANH], cell salvage, and drugs); use of guidelines; and perceptions about the appropriateness of current levels of use., Results: Survey 1 was returned by 349 of 400 hospitals (87%) and Survey 2 by 324 of 578 surgical units (56%). Preoperative autologous donation was most widely used (70% of hospitals), most commonly in units performing orthopaedic or vascular surgery (65% and 37%, respectively). Cell salvage and ANH were used by 27% and 24% of hospitals, respectively, most often in units performing cardiothoracic (40% and 44%, respectively) and vascular surgery (29% and 15%, respectively). These three interventions were used significantly more in private than in public hospitals (P < 0.05). Use of printed guidelines was uncommon. Respondents considered that autologous transfusion techniques should be used more widely because of their perceived efficacy and concerns about safety of allogeneic blood. Perceived barriers to greater use included lack of surgeon or physician interest, uncertain scheduling of surgery in public hospitals and cost (cell salvage). Drugs to minimise blood loss were used by fewer than 10% of hospitals., Conclusions: Interventions to minimise the need for perioperative allogeneic blood transfusion (apart from drugs) are widely used in Australia. However, enthusiasm for intraoperative techniques of re-infusing autologous blood needs to be assessed against the evidence of their efficacy and cost-effectiveness.