title: Socioeconomic determinants of outpatient antibiotic use in Europe.
abstract: OBJECTIVE
  Outpatient antibiotic consumption widely varies across Europe. The investigation of the causes of such variation may help to identify interventions that would improve the efficient use of antibiotics. The aim of this study was to assess the impact of socioeconomic determinants and the role played by information about bacterial resistance.
  
  
  METHODS
  Comparable data on systemically administered antibiotics and socioeconomic determinants in 17 European countries were available between 2000 and 2005. We estimated an ad hoc econometric model by means of a hybrid log-log functional form and random effects generalised least squares regressions. Lagged values and the instrumental variable method were applied to address endogeneity of bacterial resistance and infections. Bacterial resistance was measured by the rate of penicillin non-susceptible Streptococcus pneumoniae isolates (PNSP) and methicillin-resistant Staphylococcus aureus (MRSA).
  
  
  RESULTS
  The population income, demographic structure, density of general practitioners and their remuneration method appeared to be significant determinants of antibiotic consumption. Although countries with higher levels of bacterial resistance exhibited significantly higher levels of per capita antibiotic use, ceteris paribus, the responsiveness of antibiotic use to changes in bacterial resistance was relatively low (0.09-0.18).
  
  
  CONCLUSIONS
  The study confirms that socioeconomic factors should be taken into account while explaining differences in outpatient antibiotic use across countries. The impact of supply-side factors and incentives attached to payment schemes for physicians need to be considered in government interventions to reduce inequalities and improve effectiveness in antibiotic utilisation.
authors.affiliation: Department of Economics and Technology Management, University of Bergamo, Bergamo, Italy. giuliano.masiero@lu.unisi.ch
authors.forename: Giuliano
authors.initials: G
authors.lastname: Masiero
authors.forename: Massimo
authors.initials: M
authors.lastname: Filippini
authors.forename: Matus
authors.initials: M
authors.lastname: Ferech
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005060:Europe; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D017059:Models, Econometric; D010045:Outpatients / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011445:Prospective Payment System; D012923:Social Class
chemical_list: D000900:Anti-Bacterial Agents