[Is otitis and tonsillitis handled in the same way within normal working hours and out-of-hours?]

Several factors influence physicians' prescribing of antibiotics. The purpose of this study is to see whether physicians use diagnostic testing and prescribe antibiotics differently for acute otitis media (AOM) and tonsillitis when they work within normal working hours and out-of-hours.

The study was a retrospective study of electronic patient records in a 6-month period, from 1.09.1998 to 31.3.1999. All journal notes from the out-of-hours services and the participating general practice clinics were examined. The following variables were recorded: diagnosis, patient age and gender, use of C-reactive protein (CRP) and StrepA testing and treatment.

In the diagnosis of AOM, CRP was used in 8 % of patients cared for out-of-hours and 6 % of those treated during normal working hours. There was no significant difference between the proportion of patients treated with antibiotics out-of-hours (74 %) and within normal working hours (73 %), but individual physicians differed significantly with respect to prescription of antibiotics and use of diagnostic tests. In the diagnosis of tonsillitis, either StrepA antigen test, CRP, or both tests were used in 65 % of patients cared for out-of-hours and in 50 % of those cared for during normal working hours. There was no significant difference in the proportion of patients treated with antibiotics out-of-hours (76 %) or during normal working hours (69 %).

Individual physicians use diagnostic testing and prescribe antibiotics in a similar way within and out-of-hours, but there were significant differences between individual physicians.