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Diagnostic labelling as determinant of antibiotic prescribing for acute respiratory tract episodes in general

Huug J van Duijn1, Marijke M Kuyvenhoven, Hanneke M Tiebosch

  • 1Julius Center for Health Sciences and Primary Care, University Medical Center, Location Stratenum, room 6,109, PO Box 85060, 3508 AB Utrecht, The Netherlands. hj@vduijn.nl

BMC Family Practice
|September 22, 2007
PubMed
Abstract

Insights

General practitioners' diagnostic labeling of acute respiratory infections influences antibiotic prescribing volume, independent of episode incidence. Quality programs should promote evidence-based criteria over simple diagnostic labels for antibiotic use.

Area of Science:

  • General Practice
  • Infectious Diseases
  • Pharmacology

Background:

  • Antibiotic overprescription for acute respiratory tract (RT) episodes is a significant concern in general practice.
  • Diagnostic labeling, classifying RT episodes as infections, is a potential contributor to high antibiotic prescription volumes.
  • The independent association between diagnostic labeling and antibiotic prescribing volume, beyond episode incidence, requires investigation.

Purpose of the Study:

  • To determine if diagnostic labeling independently influences antibiotic prescription volume for acute RT episodes.
  • To investigate the relationship between diagnostic labeling, the incidence of acute RT episodes, and antibiotic prescribing patterns.

Main Methods:

  • Analysis of data from the Second Dutch National Survey of General Practice (DNSGP-2) involving 163 general practitioners (GPs) and 359,625 patients.
  • Utilized multiple linear regression analysis on 12 months of data.
  • Primary outcome measure: antibiotic prescription volume for acute RT episodes per 1,000 patients.

Main Results:

  • The incidence of acute RT episodes was 236.9 per 1,000 patients.
  • GPs labeled approximately 70% of acute RT episodes as infections, with antibiotics prescribed in 41% of cases.
  • Independent determinants of antibiotic prescribing volume included higher incidence of RT episodes (beta 0.67), inclination to label as infections (beta 0.24), belief in antibiotics for throat spots (beta 0.11), and male gender (beta 0.11). Diagnostic labeling was not correlated with episode incidence.

Conclusions:

  • Diagnostic labeling is a significant factor in GPs' antibiotic prescribing decisions, independent of the incidence of acute RT episodes.
  • Quality assurance programs and postgraduate training should emphasize evidence-based prognostic criteria (e.g., chronic respiratory co-morbidity, old age) for antibiotic prescription.
  • Avoid reliance on single inflammation signs or diagnostic labels as primary indicators for prescribing antibiotics.

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