What determines a family doctor's prescribing habits for antibiotics? A comparative study on a doctor's own behaviour in two different settings.

OBJECTIVE

To compare the author's prescribing habits for antibiotics in two different work settings and to study the reasons for the observed different trends.

DESIGN

A retrospective database study of computer-based patient records. The author's 55,261 patient contacts during a nine-year period were investigated.

SETTING

A solo practice in a small isolated fishing village, Bolungarvík, in 1984-1987, and a group practice in the town of Akureyri in 1987-1992, where the people had a free choice of doctors.

SUBJECT

The author himself was the subject of the study.

MAIN OUTCOME MEASURE

Type and number of prescriptions of antibiotics. The predictive variables were number and type of contacts, number of listed patients, age and sex of the patients, diagnosis, and the use of laboratory investigations.

RESULTS

From 1984 to 1986 the author reduced the number of his prescriptions of antibiotics from 82.9 to 63.8 per 1000 contacts (p < 0.001) in his solo practice. In the group practice the number increased from 82.6 in 1988 to 90.5 in 1992 (NS). There was an increase in the workload during the study periods, especially the latter, with a looser affiliation to the patient group. The incidence of respiratory diseases seemed to be in accordance with the frequency of prescriptions.

CONCLUSIONS

In affluent societies many family physicians should be able to reduce their number of prescriptions of antibiotics to some extent, if they are interested in doing so and have a well established relationship with their patients. A computer-based quality control is essential for that purpose, because the expectations of the patients, the surroundings of the doctor, and his work environment determine to a great extent his antibiotic prescribing habits.