Is the "practice style" hypothesis relevant for general practitioners? An analysis of antibiotics prescription for acute rhinopharyngitis
Much research in France or abroad has highlighted the medical practice variation (MPV) phenomenon. There is no consensus on the origin of MPV between preference-centered approaches versus opportunities and constraints approaches. This study's main purpose is to assess the relevance of hypotheses which assume that physicians adopt a uniform practice style for their patients for each similar clinical decision in a context of medical decision with low uncertainty and professional practice with weak regulation. Multilevel models are evaluated: first to measure variability of antibiotics prescription by French general practitioners (GPs) for acute rhinopharyngitis regarding clinical guidelines, and to test its significance in order to determine to what extent prescription differences are due to between or within GPs discrepancies; second, to prioritize its determinants, especially those relating to a GP or his/her practice setting environment, while controlling visit or patient confounders. The study was based on 2001 activity data, along with an ad hoc questionnaire, of a sample of 778 GP taken from a panel of 1006 computerized French GPs. We observed that a large part of the total variation was due to intra-physician variability (70%). It is patient characteristics that largely explain the prescription, even if GP or practice setting characteristics (location, level of activity, network participation, continuing medical education) and environmental factors (visit from pharmaceutical sales representatives) also exert considerable influence. This suggests that MPV are partly caused by differences in the type of dissemination of medical information and this may help policy makers to identify and develop facilitators for promoting better use of antibiotics in France and, more generally, for influencing GP practices when it is of interest.
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Volume (Year): 70 (2010)
Issue (Month): 8 (April)
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References listed on IDEAS
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- Casparie, Anton F., 1996. "The ambiguous relationship between practice variation and appropriateness of care: an agenda for further research," Health Policy, Elsevier, vol. 35(3), pages 247-265, March.
- Pelletier-Fleury, Nathalie & Le Vaillant, Marc & Hebbrecht, Gilles & Boisnault, Philippe, 2007. "Determinants of preventive services in general practice: A multilevel approach in cardiovascular domain and vaccination in France," Health Policy, Elsevier, vol. 81(2-3), pages 218-227, May.
- Scott, Anthony & Shiell, Alan, 1997. "Do fee descriptors influence treatment choices in general practice? A multilevel discrete choice model," Journal of Health Economics, Elsevier, vol. 16(3), pages 323-342, June.
- Phelps, Charles E., 2000. "Information diffusion and best practice adoption," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 5, pages 223-264 Elsevier.
- Wennberg, John E. & Barnes, Benjamin A. & Zubkoff, Michael, 1982. "Professional uncertainty and the problem of supplier-induced demand," Social Science & Medicine, Elsevier, vol. 16(7), pages 811-824, January.
- Duncan, Craig & Jones, Kelvyn & Moon, Graham, 1998. "Context, composition and heterogeneity: Using multilevel models in health research," Social Science & Medicine, Elsevier, vol. 46(1), pages 97-117, January.
- Davis, Peter & Gribben, Barry & Scott, Alastair & Lay-Yee, Roy, 2000. "The "supply hypothesis" and medical practice variation in primary care: testing economic and clinical models of inter-practitioner variation," Social Science & Medicine, Elsevier, vol. 50(3), pages 407-418, February.
- Eric Delattre & Brigitte Dormont, 2003. "Fixed fees and physician-induced demand: A panel data study on French physicians," Health Economics, John Wiley & Sons, Ltd., vol. 12(9), pages 741-754.
- Nigel Rice & Andrew Jones, 1997. "Multilevel models and health economics," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 561-575.
- McGuire, Thomas G., 2000. "Physician agency," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 9, pages 461-536 Elsevier.
- Sophie Béjean & Christine Peyron & Renaud Urbinelli, 2007.
"Variations in activity and practice patterns: a French study for GPs,"
The European Journal of Health Economics,
Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(3), pages 225-236, September.
- Sophie Béjean & Christine Peyron & Renaud Urbinelli, 2007. "Variations in activity and practice patterns: a French study for GPs," Post-Print halshs-00185322, HAL.
- Charles E. Phelps, 1995. "Perspectives in health economics," Health Economics, John Wiley & Sons, Ltd., vol. 4(5), pages 335-353, 09.
- Paraponaris, A. & Verger, P. & Desquins, B. & Villani, P. & Bouvenot, G. & Rochaix, L. & Gourheux, J. C. & Moatti, J. P. AU -, 2004. "Delivering generics without regulatory incentives?: Empirical evidence from French general practitioners about willingness to prescribe international non-proprietary names," Health Policy, Elsevier, vol. 70(1), pages 23-32, October. Full references (including those not matched with items on IDEAS)