Indicators show differences in antibiotic use between general practitioners and paediatricians
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The purpose of this investigation was to adapt to an individual physician level and to the paediatric context a set of drug-specific indicators of outpatient antibiotic use developed by the European Surveillance of Antimicrobial Consumption (ESAC) project, and to describe the differences in antibiotic prescriptions between general practitioners (GPs) and paediatricians. We conducted a retrospective cross-sectional study analysing antibiotic prescriptions in 2009 for children below 16 years of age in south-eastern France, using the National Health Insurance (NHI) outpatient reimbursement database. A generalised linear model adjusted on physicians’ characteristics and patient population characteristics was used to compare indicators between GPs and paediatricians. We included 4,921 self-employed GPs and 301 paediatricians. Penicillins accounted for 47 % and 45 % of all antibiotics prescribed by GPs and paediatricians, respectively, followed by cephalosporins (33 % and 39 %) and macrolides (14 % and 9 %). In both specialties, there were around 70 % more antibiotic prescriptions during the winter quarters compared to the summer quarters. The 13 indicators we calculated showed wide variations in antibiotic prescriptions among GPs, among paediatricians, and between GPs and paediatricians. In an adjusted econometric model, GPs were found to issue 54 % more antibiotic prescriptions than paediatricians, whereas paediatricians used a significantly higher proportion of co-amoxiclav (18 % vs. 12 %) and cephalosporins (39 % vs. 33 %) and a significantly lower proportion of macrolides (9 % vs. 14 %) compared to GPs. A set of 13 indicators may be calculated using reimbursement data to describe outpatient antibiotic use at the physician level. We observed very different prescribing profiles between GPs and paediatricians.
KeywordsCephalosporin Macrolides National Health Insurance Antibiotic Prescription Cefpodoxime
We thank Steve Nauleau for providing the NHI database, as well as Hervé Haas and Anne Caherec for their helpful comments. We are grateful to Brigitte Dunais for her help with the language editing.
Conflict of interest
There are no conflicts of interest relevant to this work for all authors.
The work of Céline Pulcini was supported by the “Infectiopole Sud” foundation (a non-profit-making foundation, http://www.infectiopolesud.com/), which paid for her accommodation and travel expenses during her time in Marseille. This foundation played no part in the study design; the collection, analysis and interpretation of data; the writing of the paper; or the decision to submit this paper for publication.
C.P. designed the study, wrote the protocol and the article. C.L. performed the statistical analysis and reviewed the article. B.V. and P.V. reviewed the study protocol and the article.
- 5.Bocquet A, Chalumeau M, Bollotte D, Escano G, Langue J, Virey B (2005) Comparison of prescriptions by pediatricians and general practitioners: a population-based study in Franche-Comté from the database of Regional Health Insurance Fund. Arch Pediatr 12(12):1688–1696. doi: 10.1016/j.arcped.2005.06.014 PubMedCrossRefGoogle Scholar
- 8.Adriaenssens N, Coenen S, Tonkin-Crine S, Verheij TJ, Little P, Goossens H; on behalf of the ESAC Project Group (2011) European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing. BMJ Qual Saf. doi: 10.1136/bmjqs.2010.049049
- 10.Pulcini C, Lions C, Ventelou B, Verger P (2012) Approaching the quality of antibiotic prescriptions in primary care using reimbursement data. Eur J Clin Microbiol Infect Dis. doi: 10.1007/s10096-012-1743-2
- 11.Pulcini C, Lions C, Ventelou B, Verger P (2012) Drug-specific quality indicators assessing outpatient antibiotic use among French general practitioners. Eur J Public Health. doi: 10.1093/eurpub/cks100
- 12.Coenen S, Ferech M, Haaijer-Ruskamp FM, Butler CC, Vander Stichele RH, Verheij TJ, Monnet DL, Little P, Goossens H; ESAC Project Group (2007) European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe. Qual Saf Health Care 16(6):440–445. doi: 10.1136/qshc.2006.021121 PubMedCrossRefGoogle Scholar
- 13.Adriaenssens N, Coenen S, Versporten A, Muller A, Minalu G, Faes C, Vankerckhoven V, Aerts M, Hens N, Molenberghs G, Goossens H; ESAC Project Group (2011) European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe (1997–2009). J Antimicrob Chemother 66(Suppl 6):vi3–vi12. doi: 10.1093/jac/dkr453 PubMedCrossRefGoogle Scholar
- 17.Pradier C, Rotily M, Cavailler P, Haas H, Pesce A, Dellamonica P, Obadia Y (1999) Factors related to the prescription of antibiotics for young children with viral pharyngitis by general practitioners and paediatricians in southeastern France. Eur J Clin Microbiol Infect Dis 18(7):510–514PubMedCrossRefGoogle Scholar
- 20.Arguedas A, Emparanza P, Schwartz RH, Soley C, Guevara S, de Caprariis PJ, Espinoza G (2005) A randomized, multicenter, double blind, double dummy trial of single dose azithromycin versus high dose amoxicillin for treatment of uncomplicated acute otitis media. Pediatr Infect Dis J 24(2):153–161PubMedCrossRefGoogle Scholar