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Rational prescribing and interpractitioner variation. A multilevel approach

P Davis1, B Gribben

  • 1University of Auckland School of Medicine.

International Journal of Technology Assessment in Health Care
|January 1, 1995
PubMed
Summary
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Geographical variations in medical interventions and drug prescribing are significant. Even after accounting for patient and practitioner factors, prescribing rates show substantial interpractitioner variability, questioning rational therapeutics.

Area of Science:

  • Health Services Research
  • Medical Practice Variation
  • Pharmaceutical Policy

Background:

  • Geographical variations in medical and surgical interventions are well-documented across all practice levels.
  • Similar patterns of variability exist in the prescription and consumption of therapeutic drugs.
  • Understanding these variations is crucial for healthcare policy and practice improvement.

Purpose of the Study:

  • To confirm and quantify the extent of variability in drug prescribing within general practice.
  • To identify the contribution of interpractitioner differences to overall prescribing variability.
  • To explore the implications of this variability for rational therapeutics.

Main Methods:

  • Utilized survey data from general practice in New Zealand.

Related Experiment Videos

  • Employed multilevel modeling techniques to analyze prescribing data.
  • Controlled for patient, diagnostic, and practitioner-specific variables.

    • Main Results:

    • Confirmed extensive variability in drug prescribing rates among general practitioners.
    • Multilevel modeling identified a significant interpractitioner component in prescribing variation.
    • Controlling for other variables did not reduce the observed interpractitioner prescribing variability.

    Conclusions:

    • Significant interpractitioner variability in prescribing exists, independent of patient and diagnostic factors.
    • Clinical uncertainty and professional autonomy may contribute to prescribing variations.
    • Further research is needed to promote rational therapeutics amidst practice variation.