Method of physician remuneration and rates of antibiotic prescription

Background: Rates of antibiotic prescription in Canada far exceed generally accepted rates of bacterial infection, which led the authors to postulate that rates of antibiotic prescription depend to some extent on factors unre lated to medical indication. The associations between antibiotic prescripti on rates and physician characteristics, in particular, method of remunerati on and patient volume, were explored. Methods: The authors evaluated all 153047 antibiotic prescriptions generate d by 476 Newfoundland general practitioners and paid for by the Newfoundlan d Drug Plan over the 1-year period ending Aug. 31, 1996, and calculated rat es of antibiotic prescription. Linear and logistic regression models contro lling for several physician characteristics, specifically age, place of edu cation (Canada or elsewhere), location of practice (urban or rural) and pro portion of elderly patients seen, were used to analyse rates of antibiotic prescription. Results: Fee-for-service payment (rather than salary) and greater volume of patients were strongly associated with higher antibiotic prescription rate s. Fee-for-service physicians were much more likely than their salaried cou nterparts to prescribe at rates above the median value of 1.51 antibiotic p rescriptions per unique patient per year. The association between rate of a ntibiotic prescription and patient volume (as measured by number of unique patients prescribed to) was evident for all physicians. However, the associ ation was much stronger for fee-for-service physicians. Physicians with hig her patient volumes prescribed antibiotics at higher rates. Interpretation: In this study factors other than medical indication, in par ticular method of physician remuneration and patient volume, played a major role in determining antibiotic prescribing practices.