Relationship between general practitioner certification and characteristics of care.
BACKGROUND
The introduction of mandatory or quasimandatory certification processes for general/family doctors has become common in many countries, including Australia. Whether certification effects the care provided is rarely investigated.


OBJECTIVE
The objective of this study was to determine whether certification of general/family physicians is associated with clinical performance.


METHODS
We conducted a secondary comparative analysis of data from an Australian national cross-sectional survey (April 2000-March 2002).


METHODS
Subjects consisted of a random sample of 1982 general practitioners (GPs)


METHODS
Each participant provided demographic details and information about 100 consecutive patient encounters (total 197,500). We compared characteristics of certified and uncertified general practitioners (GPs), their patients, encounters, problems, management actions, and tested 34 performance indicators. We investigated whether differences identified in descriptive analyses were explained by other factors.


RESULTS
Of 1975 GPs who indicated certification status, 659 (33.4%) were vocationally certified. Certificants were more likely to be female, younger, Australian graduates, working fewer sessions, in larger practices, in accredited practices, and using computers for clinical purposes. Their patients were younger, more often female, and less likely to hold a healthcare concession card. Their consultations were longer; they prescribed fewer medications and more clinical treatments and procedures, ordered more pathology tests, and referred more to other health professionals. After adjustment for GP/practice, patient and morbidity differences, certificants had longer consultations, did more therapeutic procedures, prescribed less overall, prescribed fewer nonsteroidal antiinflammatory drugs in the elderly, and fewer antibiotics for upper respiratory infections.


CONCLUSIONS
Certification of general practitioners has a significant association with consultation behavior and patient management.
Miller
Graeme
G
Family Medicine Research Centre, University of Sydney, Australia. gmiller@med.usyd.edu.au
Britt
Helena
H
Pan
Ying
Y
Knox
Stephanie
S
D000328:Adult; D001315:Australia; D002568:Certification; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D005194:Family Practice / Q000193:education / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D013044:Specialty Boards