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A refutation of the practice style hypothesis: the case of antibiotics prescription by French general practitioners for acute rhinopharyngitis

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Author Info

  • Julien Mousquès

    ()
    (IRDES institut for research and information in health economics)

  • Thomas Renaud

    ()
    (IRDES institut for research and information in health economics)

  • Olivier Scemama

    ()
    (HAS French National Authority for Health)

Abstract

Many researches in France or abroad have highlighted the medical practice variation (MPV)phenomenon, or even the inappropriateness of certain medical decisions. There is no consensus on the origin of this MPV between preference-centred versus opportunities and constraints approaches. This study principal purpose is to refute hypothesis which assume that physicians adopt for their patient a uniform practice style for each similar clinical decision beyond the time. More specifically, multilevel models are estimated: First to measure variability of antibiotics prescription by French general practitioners for acute rhinopharyngitis, a clinical decision making context with weak uncertainty, and to tests its significance; Second to prioritize its determinants, especially those relating to GP or its practice setting environment, by controlling visit or patient confounders. The study was based on the 2001 activity data, added by an ad hoc questionnaire, of a sample of 778 GPs arising from a panel of 1006 computerized French GPs. We observe that a great part of the total variation was due to intra-physician variability (70%). Hence, in the French general practice context, we find empirical support for the rejection of the ‘practice style’, the ’enthusiasm’ or the ‘surgical signature’ hypothesis. Thus, it is patients' characteristics that largely explain the prescription, even if physicians' characteristics (area of practice, level of activity, network participation, participation in ongoing medical training) and environmental factors (recent visit from pharmaceutical sales representatives) also exert considerable influence. The latter suggest that MPV are partly caused by differences in the type of dissemination or diffusion of information. Such findings may help us to develop and identify facilitators for promoting a better use of antibiotics in France and, more generally, for influencing GPs practice when it is of interest.

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File URL: http://www.irdes.fr/EspaceAnglais/Publications/WorkingPapers/DT18RefutationPracticeAntibioticPrescriptionRhinopharyngitis.pdf
File Function: First version, 2008
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Bibliographic Info

Paper provided by IRDES institut for research and information in health economics in its series Working Papers with number DT18.

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Length: 24 pages
Date of creation: Oct 2008
Date of revision: Oct 2008
Handle: RePEc:irh:wpaper:dt18

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Related research

Keywords: Medical practice variation; Multilevel analysis; Upper respiratory tract infections; Rhinopharyngitis; Antibiotics; General practitioners; Panel; France;

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References

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Cited by:
  1. Thierry Debrand & Christine Sorasith, 2010. "Out-of-Pocket Maximum Rules under a Compulsatory Health Care Insurance Scheme: A Choice between Equality and Equity," Working Papers DT34, IRDES institut for research and information in health economics, revised Nov 2010.

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