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Who Are the High Prescribers?

Arch G. Mainous III, PhD; William J. Hueston, MD; Margaret M. Love, PhD

Arch Pediatr Adolesc Med. 1998;152:349-352.

Objective  To examine physician characteristics associated with being a high prescriber of antibiotics for pediatric upper respiratory tract infections (URIs).

Design and Setting  Analysis of 34624 episodes of care for URIs in children (younger than 18 years) in the Kentucky Medicaid program from July 1, 1995, to June 30, 1996.

Participants  Primary care physicians with at least 25 episodes of care (n=205). The proportion of patients with URIs receiving antibiotics stratified the sample into low (25th percentile) and high (75th percentile) antibiotic prescribers.

Main Outcome Measures  Bivariate analyses were computed comparing the high and low prescribers. A logistic regression model was computed for likelihood of being a high prescriber by number of URI episodes, proportion of patients receiving antibiotics that were broad spectrum, years since medical school graduation, physician gender, rural/urban practice, and specialty.

Results:  The high prescriber group (n=52) included data from 11899 episodes of care, with a mean prescribing rate of 80%. The low prescriber group (n=55) included data from 5396 episodes, with a mean prescribing rate of 16%. High prescribers were significantly more years away from medical school graduation (27 vs 19 years; P <.001) and had managed significantly more URI episodes than low prescribers (229 vs 98; P=.001). In the logistic regression, compared with pediatricians, the odds ratios of being a high prescriber were 409 (95% confidence interval [CI], 29-7276) for family practitioners and 318 (95% CI, 17-6125) for other primary care physicians.

Conclusion  With the rise of antibiotic-resistant bacteria, more focused training regarding treatment of URIs is warranted in residency and in continuing medical education forums.

From the Department of Family Practice, University of Kentucky, Lexington (Drs Mainous and Love), and the Department of Family Medicine, University of Wisconsin, Madison (Dr Hueston). Drs Mainous and Hueston are now at the Department of Family Medicine, Medical University of South Carolina, Charleston.

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