title: Antibiotic prescribing in primary care by international medical graduates and graduates from Swedish medical schools.
abstract: BACKGROUND
  Studies of antibiotic prescribing related to diagnosis comparing prescribers trained abroad with those trained in Sweden are lacking.
  
  
  OBJECTIVE
  To determine whether general practices (GPs) and GP residents trained abroad had different prescribing patterns for antibiotics for common infections than those trained in Sweden using retrospective data from electronic patient records from primary health care in Kalmar County, Sweden.
  
  
  METHODS
  Consultations with an infection diagnosis, both with and without the prescription of antibiotics to 67 GPs and residents trained in Western Europe outside Sweden and other countries, were compared with a matched control group trained in Sweden.
  
  
  RESULTS
  For 1 year, 44101 consultations of patients with an infection diagnosis and 16276 prescriptions of antibiotics were registered. Foreign-trained physicians had 20% more visits compared with physicians trained in Sweden. The prescription of antibiotics per visit and physician in the respective groups, and independent of diagnosis, did not significantly differ between groups, when scaled down from number of consultations to number of prescribing physicians.
  
  
  CONCLUSIONS
  There were minor and non-significant differences in antibiotic prescribing comparing GPs and residents trained abroad and in Sweden, most likely the result of an adaptation to Swedish conditions. Nevertheless, no group prescribed antibiotics in accordance to national guidelines. The results suggest that interventions are needed to reduce irrational antibiotic prescribing patterns, targeting all physicians working in Swedish primary health care.
authors.affiliation: Primary Health Centre, Lindsdal, Kalmar, Department of Planning, Division of Pharmacotherapy, Kalmar County Council, Kalmar, thomas.neumark@ltkalmar.se.
authors.forename: Thomas
authors.initials: T
authors.lastname: Neumark
authors.affiliation: Department of Clinical Physiology, Kalmar County Hospital, Kalmar and.
authors.forename: Lars
authors.initials: L
authors.lastname: Brudin
authors.affiliation: Department of Clinical Sciences, General Practice, Lund University, Malmö, Sweden.
authors.forename: Sigvard
authors.initials: S
authors.lastname: Mölstad
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data*; D004501:Education, Medical / Q000706:statistics & numerical data; D057286:Electronic Health Records; D005260:Female; D005550:Foreign Medical Graduates / Q000592:standards / Q000706:statistics & numerical data*; D005843:Geography; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012577:Schools, Medical / Q000706:statistics & numerical data; D013548:Sweden
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prescribing; antibiotics; family practice; medical education; primary health care; trained abroad.