A refutation of the practice style hypothesis: the case of antibiotics prescription by French general practitioners for acute rhinopharyngitis
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.
|Date of creation:||Oct 2008|
|Date of revision:||Oct 2008|
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- 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.
- Nigel Rice & Andrew Jones, 1997. "Multilevel models and health economics," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 561-575.
- Sophie Béjean & Christine Peyron & Renaud Urbinelli, 2007.
"Variations in activity and practice patterns: a French study for GPs,"
- 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.
- 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.
- 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.
- Westert, Gert P. & Groenewegen, Peter P., 1999. "Regional disparities in health care supply in eleven European countries: does politics matter?," Health Policy, Elsevier, vol. 47(2), pages 169-182, May.
- 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.
- 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.
- de Jong, Judith D. & Groenewegen, Peter P. & Westert, Gert P., 2003. "Mutual influences of general practitioners in partnerships," Social Science & Medicine, Elsevier, vol. 57(8), pages 1515-1524, October.
- Anthony Scott & Alan Shiell, 1997. "Analysing the effect of competition on General Practitioners' behaviour using a multilevel modelling framework," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 577-588.
- 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.
- 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.
- 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.
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