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Predictors of inappropriate antibiotic prescribing among primary care physicians

From the Department of Epidemiology and Biostatistics (Cadieux, Tamblyn) and the Department of Medicine (Tamblyn, Dauphinee), McGill University, and the Division of Infectious Diseases and Department of Medical Microbiology (Libman), Montréal General Hospital, Montréal, Que.

Correspondence to: Ms. Genevieve Cadieux, Department of Epidemiology and Biostatistics, McGill University, 1140 Pine Ave. W, Montréal QC H3A 1A3; genevieve.cadieux{at}mail.mcgill.ca

Background: Inappropriate use of antibiotics promotes antibiotic resistance. Little is known about physician characteristics that may be associated with inappropriate antibiotic prescribing. Our objective was to assess whether physician knowledge, time in practice, place of training and practice volume explain the differences in antibiotic prescribing among physicians.

Methods: A historical cohort of 852 primary care physicians in Quebec who became certified between 1990 and 1993 was followed for their first 6–9 years of practice (1990–1998). We evaluated whether inappropriate antibiotic prescribing had occurred during the study period (1990–1998) for viral (prescription of antibiotics) and bacterial (prescription of second-or third-line antibiotics given orally) infections. We used logistic regression to estimate the independent contributions of time in practice, practice volume, place of medical training and scores on licensure examinations. Physician sex and visit setting were controlled for, as were patient age, sex, education, income and geographic area of residence.

Results: A total of 104 230 patients who received a diagnosis of a viral infection and 65 304 who received a diagnosis of a bacterial infection were included in our study. International medical graduates were more likely than University of Montréal graduates to prescribe antibiotics for viral respiratory infections (risk ratio [RR] 1.78, 95% confidence interval [CI] 1.30–2.44). Inappropriate antibiotic prescribing increased with time in practice. Physicians with a high practice volume were more likely than those with low practice volume to prescribe antibiotics for viral respiratory infections (RR 1.27, 95% CI 1.09–1.48) and to prescribe second-and third-line antibiotics as first-line treatment (RR 1.20, 95% CI 1.06–1.37). Physician scores on licensure examinations were not predictive of inappropriate antibiotic prescribing.

Interpretation: International medical graduates, physicians with high-volume practices and those who were in practice longer were more likely to prescribe antibiotics inappropriately. Developing effective interventions will require increased knowledge of the mechanisms that underlie these predictors of inappropriate antibiotic prescribing.

This article has been cited by other articles:

				S. K. Glass, D. L. Pearl, S. A. McEwen, and R. Finley Canadian province-level risk factor analysis of macrolide consumption patterns (2000-2006) J. Antimicrob. Chemother., October 28, 2009; (2009) dkp391v1. [Abstract] [Full Text] [PDF]

				C. T. Naugler Evolutionary medicine: Update on the relevance to family practice Can Fam Physician, September 1, 2008; 54(9): 1265 - 1269. [Abstract] [Full Text] [PDF]

				S. Strickland Review: delayed or immediate antibiotic prescriptions have similar clinical outcomes in respiratory infections Evid. Based Nurs., April 1, 2008; 11(2): 46 - 46. [Full Text] [PDF]

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