Role of diagnostic labeling in antibiotic prescription

OBJECTIVE To evaluate the association between diagnostic labeling of respir atory tract infections (RTIs) and antibiotic prescription rates in family p ractice. DESIGN Descriptive analysis of outpatient chart review supplemented by inte rviews with physicians. Charts of patients attending 73 general practitione rs were reviewed between October 1997 and February 1998. Two days of practi ce were evaluated per physician. SETTING Urban family practices in greater St John's, Nfld. PARTICIPANTS Of 96 family physicians contacted, 73 (76%) agreed to particip ate. MAIN OUTCOME MEASURES Rates of diagnoses and antibiotic prescriptions for a cute infections. Physicians were divided into "low prescribers" and "high p rescribers" based on overall rates of prescription to patients with infecti ons. Low prescribers were compared with high prescribers with respect to ph ysician characteristics, patient characteristics, and diagnoses assigned. RESULTS Of all patients seen, 22% were seen for acute infections; RTIs acco unted for 76% of diagnoses. Low prescribers and high prescribers were of si milar ages and saw similar numbers of patients of similar ages with very si milar presenting complaints. Both groups diagnosed urinary tract and skin a nd self-tissue infections at similar rates, but differed markedly in their rates of diagnoses of RTIs. High prescribers diagnosed bacterial RTIs in 65 .4% (147/225) of their patients; low prescribers diagnosed bacterial RTIs i n 31.0% (66/213) (P < .001). CONCLUSION Family doctors frequently prescribe antibiotics. The difference in rates of prescription between high prescribers and low prescribers is la rgely explained by assignment of diagnoses of RTIs.