Eggermont D, Smit M A M, Kwestroo G A, Verheij R A, Hek K, Kunst A E
Department of Public Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105, AZ, the Netherlands.
Netherlands Institute for Health Services Research (Nivel), Otterstraat 118-124, Utrecht, 3513, CR, the Netherlands.
BMC Fam Pract. 2018 Nov 17;19(1):175. doi: 10.1186/s12875-018-0859-6.
Patient gender as well as doctor gender are known to affect doctor-patient interaction during a medical consultation. It is however not known whether an interaction of gender influences antibiotic prescribing. This study examined GP's prescribing behavior of antibiotics at the first presentation of patients with sore throat symptoms in primary care. We investigated whether GP gender, patient gender and gender concordance have an effect on the GP's prescribing behavior of antibiotics in protocolled and non-protocolled diagnoses.
We analyzed electronic health record data of 11,285 GP practice consultations in the Netherlands in 2013 extracted from the Nivel Primary Care Database. Our primary outcome was the prescription of antibiotics for throat symptoms. Sore throat symptoms were split up in 'protocolled diagnoses' and 'non-protocolled diagnoses'. The association between gender concordance and antibiotic prescription was estimated with multilevel regression models that controlled for patient age and comorbidity.
Antibiotic prescription was found to be lower among female GPs (OR 0.88, CI 95% 0.67-1.09; p = .265) and female patients (OR 0.93, 95% 0.84-1.02; p = .142), but observed differences were not statistically significant. The difference in prescription rates by gender concordance were small and not statistically significant in non-protocolled consultations (OR 0.92, OR 95% CI: 0.83-1.01; p = .099), protocolled consultations (OR 1.00, OR 95% CI: 0.68-1.32; p = .996) and all GP practice consultations together (OR 0.92, OR 95% CI: 0.82-1.02; p = .118). Within the female GP group, however, gender concordance was associated with reduced prescribing of antibiotics (OR 0.85, OR 95% CI: 0.72-0.99; p = 0.034).
In this study, female GPs prescribed antibiotics less often than male GPs, especially in consultation with female patients. This study shows that, in spite of clinical guidelines, gender interaction may influence the prescription of antibiotics with sore throat symptoms.
众所周知，患者性别以及医生性别会影响医疗咨询过程中的医患互动。然而，性别交互作用是否会影响抗生素的处方尚不清楚。本研究调查了全科医生（GP）在初级医疗中首次接诊有喉咙痛症状患者时的抗生素处方行为。我们研究了全科医生性别、患者性别以及性别一致性是否会对全科医生在标准化诊断和非标准化诊断中抗生素的处方行为产生影响。
我们分析了2013年从荷兰Nivel初级医疗数据库中提取的11285次全科医生诊疗的电子健康记录数据。我们的主要结果是针对喉咙症状开具抗生素处方。喉咙痛症状被分为“标准化诊断”和“非标准化诊断”。通过控制患者年龄和合并症的多水平回归模型估计性别一致性与抗生素处方之间的关联。
发现女性全科医生（比值比[OR]0.88，95%置信区间[CI]0.67 - 1.09；p = 0.265）和女性患者（OR 0.93，95% CI 0.84 - 1.02；p = 0.142）的抗生素处方率较低，但观察到的差异无统计学意义。在非标准化诊疗（OR 0.92，95% CI：0.83 - 1.01；p = 0.099）、标准化诊疗（OR 1.00，95% CI：0.68 - 1.32；p = 0.996）以及所有全科医生诊疗（OR 0.92，95% CI：0.82 - 1.02；p = 0.118）中，性别一致性导致的处方率差异较小且无统计学意义。然而，在女性全科医生组中，性别一致性与抗生素处方减少相关（OR 0.85，95% CI：0.72 - 0.99；p = 0.034）。
在本研究中，女性全科医生开具抗生素的频率低于男性全科医生，尤其是在诊治女性患者时。这项研究表明，尽管有临床指南，但性别交互作用可能会影响有喉咙痛症状患者的抗生素处方。
