Method of physician remuneration and rates of antibiotic prescription.
BACKGROUND
Rates of antibiotic prescription in Canada far exceed generally accepted rates of bacterial infection, which led the authors to postulate that rates of antibiotic prescription depend to some extent on factors unrelated to medical indication. The associations between antibiotic prescription rates and physician characteristics, in particular, method of remuneration and patient volume, were explored.


METHODS
The authors evaluated all 153,047 antibiotic prescriptions generated by 476 Newfoundland general practitioners and paid for by the Newfoundland Drug Plan over the 1-year period ending Aug. 31 1996, and calculated rates of antibiotic prescription. Linear and logistic regression models controlling for several physician characteristics, specifically age, place of education (Canada or elsewhere), location of practice (urban or rural) and proportion of elderly patients seen, were used to analyse rates of antibiotic prescription.


RESULTS
Fee-for-service payment (rather than salary) and greater volume of patients were strongly associated with higher antibiotic prescription rates. Fee-for-service physicians were much more likely than their salaried counterparts to prescribe at rates above the median value of 1.51 antibiotic prescriptions per unique patient per year. The association between rate of antibiotic prescription and patient volume (as measured by number of unique patients prescribed to) was evident for all physicians. However, the association was much stronger for fee-for-service physicians. Physicians with higher patient volumes prescribed antibiotics at higher rates.


CONCLUSIONS
In this study factors other than medical indication, in particular method of physician remuneration and patient volume, played a major role in determining antibiotic prescribing practices.
Hutchinson
J M
JM
Division of Medicine and Clinical Epidemiology, Faculty of Medicine, Memorial University of Newfoundland, St. John's. hcc.hutj@hccsj.nf.ca
Foley
R N
RN
D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005194:Family Practice / Q000191:economics / Q000458:organization & administration*; D018588:Fee-for-Service Plans / Q000191:economics; D006302:Health Services Research; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008875:Middle Aged; D009523:Newfoundland and Labrador; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D012456:Salaries and Fringe Benefits / Q000191:economics; D016526:Workload
D000900:Anti-Bacterial Agents