title: Influence of patient payment on antibiotic prescribing in Irish general practice: a cohort study.
abstract: BACKGROUND
  Antibiotics are widely believed to be overused and misused. Approximately 80% of all prescriptions for antibiotics are written by GPs. There are many external factors that influence a GP's decision to prescribe, including patient pressure. Access to primary care services operates on a two-tier system in the Republic of Ireland: General Medical Service (GMS) card holders have free access to GPs and medications; and non-card holders (private patients) must pay a non-subsidised fee to visit their GP.
  
  
  OBJECTIVE
  To ascertain whether there was a difference in antibiotic prescribing practice between those who pay a fee for their GP consultation and those who attend free of charge.
  
  
  METHODS
  Cohort study in Irish general practice.
  
  
  METHODS
  All GPs attending continuing medical education (CME) groups nationwide were invited to participate from October 2008 until April 2010. GPs gathered data on 100 consecutive consultations including diagnosis and patient characteristics.
  
  
  RESULTS
  Data were collected from 171 GPs (distributed throughout Ireland), which resulted in 16 899 consultations. Antibiotics were prescribed at 3407 (20.16%) consultations. Nearly half of the prescriptions were for GMS card holders (n = 1669; 48.99%) and 1526 (44.79%) were for private patients; for 212 (6.22%) the payment status of the patient was unknown. Private patients were more likely to receive a prescription for antibiotics (odds ratio 1.23, 95% confidence interval = 1.14 to 1.33).
  
  
  CONCLUSIONS
  These results demonstrate that a GP's decision to provide a prescription for antibiotics may be influenced by whether or not the patient pays for their consultation at the GP interface. Private patients are more likely than GMS card holders to receive a prescription for antibiotics.
authors.affiliation: Department of General Practice, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: Marion
authors.initials: M
authors.lastname: Murphy
authors.forename: Stephen
authors.initials: S
authors.lastname: Byrne
authors.forename: Colin P
authors.initials: CP
authors.lastname: Bradley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D058006:General Practice / Q000191:economics*; D006801:Humans; D007223:Infant; D007494:Ireland; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011306:Prescription Fees / Q000706:statistics & numerical data*; D011331:Private Practice / Q000191:economics / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents