To prescribe - or not to prescribe - antibiotics: District physicians’ habits vary greatly, and are difficult to change

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Abstract
Objective - To study how different doctors at a primary health care centre prescribe antibiotics for respiratory tract infections, and, if possible, to identify reasons for differences in prescribing habits. Design - All medical visits to the health centre because of respiratory tract infections during January and February were studied in four consecutive years (1990-1993). the principles for prescribing antibiotics were discussed continously to obtain more uniform routines. Setting - the health centre of Teleborg serves a suburban district with about 10 000 inhabitants, and rural surroundings with another 2 000 inhabitants. Subjects - All 2150 visits because of respiratory tract infections (except acute otitis media) made during the studied eight months. All physicians employed at the health centre (five physicians were employed for the whole study period). Main outcome measures - Percentage of visits resulting in prescription of antibiotics, and diagnoses given. Results - Antibiotics were prescribed for 76% of the patients by the most generous doctor, but only for 21 % by the most restrictive one. the use of diagnoses suggesting bacterial infection varied in a similar way. Otherwise, the patients of the various doctors looked very much the same, and the return visits for the same complaint during the study months were about 5% for all doctors. in spite of the on-going policy discussions, the doctors kept their positions as generous or restrictive prescribes throughout the study period. Conclusion - Doctors have an individual and very constant pattern of prescribing antibiotics, and it seems that the diagnoses are often given to justify the treatment, rather than the other way round.