Is the “practice style” hypothesis relevant for general practitioners? An analysis of antibiotics prescription for acute rhinopharyngitis

Abstract

Much research in France or abroad has highlighted the medical practice variation (MPV) phenomenon. There is no consensus on the origin of MPV between preference-centered approaches versus opportunities and constraints approaches. This study's main purpose is to assess the relevance of hypotheses which assume that physicians adopt a uniform practice style for their patients for each similar clinical decision in a context of medical decision with low uncertainty and professional practice with weak regulation. Multilevel models are evaluated: first to measure variability of antibiotics prescription by French general practitioners (GPs) for acute rhinopharyngitis regarding clinical guidelines, and to test its significance in order to determine to what extent prescription differences are due to between or within GPs discrepancies; second, to prioritize its determinants, especially those relating to a GP or his/her practice setting environment, while controlling visit or patient confounders. The study was based on 2001 activity data, along with an ad hoc questionnaire, of a sample of 778 GP taken from a panel of 1006 computerized French GPs. We observed that a large part of the total variation was due to intra-physician variability (70%). It is patient characteristics that largely explain the prescription, even if GP or practice setting characteristics (location, level of activity, network participation, continuing medical education) and environmental factors (visit from pharmaceutical sales representatives) also exert considerable influence. This suggests that MPV are partly caused by differences in the type of dissemination of medical information and this may help policy makers to identify and develop facilitators for promoting better use of antibiotics in France and, more generally, for influencing GP practices when it is of interest.

Socio-demographic factors and long-term use of benzodiazepines in patients with depression, anxiety or insomnia

“…For example, general interventions targeting all PHCCs rather than certain PHCCs might be more efficient, as the long term users were not clustered within certain PHCCs. The finding of a very low ICC at the PHCC level is in contrast to several other studies investigating variation in prescription patterns between health care centres (Fang et al, 2009;Mercuri and Gafni, 2011;Mousques et al, 2010;Rogers et al, 2007). However, those studies used other outcomes and it is possible that prescription patterns regarding longterm use of benzodiazepines are more related to individual-level factors than area-level factors.…”

“…Former studies have shown that there is a considerable variation in prescription patterns between health care centres (Fang et al, 2009;Mercuri and Gafni, 2011;Mousques et al, 2010;Rogers et al, 2007). Such contextual factors may include the location of the health care centre (urban/rural), neighbourhood socioeconomic factors, the prescribing culture of physicians, and resources available in the health care centre.…”

How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study

“…Female GPs may tolerate less uncertainty than male GPs,71 but may practice being more patient-centered and spend more time on patients,72 perhaps enabling female GPs to better deal with uncertainty. GPs in high-frequented practices may be more likely to prescribe antibiotics as this is least time consuming73 and GPs who practice in urban areas with better access to specialists may refer more patients than those in rural areas. However, this may reflect other differences between urban and rural practices 74.…”

Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data

“…For instance, it would have been interesting to know whether the GPs who volunteered to sign the CAPI were more likely to practice in the regulated fee sector ('Sector 1' with capped fees) or the unregulated fee sector ('Sector 2' allowing GPs to bill additional discretionary fees). In France, it has been suggested that the type of sector could impact GPs' medical decision strategy for maintaining or increasing their income [40]. Last, although the EGB database enables us to define an objective measure of breast cancer screening using the common classification of medical procedures, it does not allow us to exclude considerations related to diagnoses rather than screening.…”