Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, H3A 1G1, Montreal, QC, Canada.
Department of Medicine, McGill University Health Center, Montreal, QC, Canada.
BMC Med Educ. 2023 Nov 1;23(1):821. doi: 10.1186/s12909-023-04817-w.
There is considerable variation among physicians in inappropriate antibiotic prescribing, which is hypothesized to be attributable to diagnostic uncertainty and ineffective communication. The objective of this study was to evaluate whether clinical and communication skills are associated with antibiotic prescribing for upper respiratory infections and sinusitis.
A cohort study of 2,526 international medical graduates and 48,394 U.S. Medicare patients diagnosed by study physicians with an upper respiratory infection or sinusitis between July 2014 and November 2015 was conducted. Clinical and communication skills were measured by scores achieved on the Clinical Skills Assessment examination administered by the Educational Commission for Foreign Medical Graduates (ECFMG) as a requirement for entry into U.S residency programs. Medicare Part D data were used to determine whether patients were dispensed an antibiotic following an outpatient evaluation and management visit with the study physician. Physician age, sex, specialty and practice region were retrieved from the ECFMG databased and American Medical Association (AMA) Masterfile. Multivariate GEE logistic regression was used to evaluate the association between clinical and communication skills and antibiotic prescribing, adjusting for other physician and patient characteristics.
Physicians prescribed an antibiotic in 71.1% of encounters in which a patient was diagnosed with sinusitis, and 50.5% of encounters for upper respiratory infections. Better interpersonal skills scores were associated with a significant reduction in the odds of antibiotic prescribing (OR per score decile 0.93, 95% CI 0.87-0.99), while greater proficiency in clinical skills and English proficiency were not. Female physicians, those practicing internal medicine compared to family medicine, those with citizenship from the US compared to all other countries, and those practicing in southern of the US were also more likely to prescribe potentially unnecessary antibiotics.
Based on this study, physicians with better interpersonal skills are less likely to prescribe antibiotics for acute sinusitis and upper respiratory infections. Future research should examine whether tailored interpersonal skills training to help physicians manage patient expectations for antibiotics could reduce unnecessary antibiotic prescribing.
医生在开具不适当的抗生素处方方面存在很大差异，这被认为是由于诊断不确定和沟通无效所致。本研究旨在评估临床和沟通技能是否与上呼吸道感染和鼻窦炎的抗生素处方有关。
对 2526 名国际医学毕业生和 48394 名美国医疗保险患者进行了队列研究，这些患者在 2014 年 7 月至 2015 年 11 月期间由研究医生诊断为上呼吸道感染或鼻窦炎。临床和沟通技能通过由外国医学毕业生教育委员会（ECFMG）管理的临床技能评估考试的分数来衡量，这是进入美国住院医师项目的要求。医疗保险部分 D 数据用于确定在研究医生进行门诊评估和管理就诊后，患者是否开了抗生素。医生的年龄、性别、专业和执业地区从 ECFMG 数据库和美国医学协会（AMA）主文件中检索。使用多变量 GEE 逻辑回归来评估临床和沟通技能与抗生素处方之间的关联，同时调整其他医生和患者特征。
在诊断为鼻窦炎的患者中，71.1%的就诊中医生开具了抗生素，上呼吸道感染的就诊中 50.5%开具了抗生素。更好的人际交往能力评分与抗生素处方的可能性降低显著相关（每十分之一评分的优势比为 0.93，95%置信区间为 0.87-0.99），而临床技能和英语水平的提高则没有。女性医生、内科医生而非家庭医生、美国公民而非其他国家的医生、以及美国南部的医生，也更有可能开出不必要的抗生素。
根据这项研究，具有更好人际交往能力的医生不太可能为急性鼻窦炎和上呼吸道感染开抗生素。未来的研究应探讨是否针对医生进行有针对性的人际交往技能培训，以帮助他们管理患者对抗生素的期望，从而减少不必要的抗生素处方。
