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Family Practice Advance Access published online on February 18, 2005
Family Practice, doi:10.1093/fampra/cmh734
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© The Author (2005). Published by Oxford University Press. All rights reserved.
Received May 18, 2004
Accepted November 26, 2004

Article

Antibiotic prescribing by ambulatory care physicians for adults with nasopharyngitis, URIs, and acute bronchitis in Taiwan: a multi-level modeling approach

Nicole Huang 1, Yiing-Jenq Chou 2, Hong-Jen Chang 3, Monto Ho 4, and Laura Morlock 5*

1 Department of Health Education, National Taiwan Normal University, Taipei, Taiwan; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Room 406, 624 N. Broadway, Baltimore MD, 21205, USA
2 Department of Social Medicine, National Yang Ming University, Taipei, Taiwan
3 Bureau of National Health Insurance, Taipei, Taiwan
4 Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, USA
5 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Room 406, 624 N. Broadway, Baltimore MD, 21205, USA

* To whom correspondence should be addressed.
Laura Morlock, E-mail: lmorlock{at}jhsph.edu


  Abstract

Background. Imprudent prescribing of antibiotics in ambulatory care in Asia is of great concern. However, an adequate understanding of factors associated with antibiotic prescribing patterns in Asia has not been achieved.

Objective. Our aim was to identify patient and physician characteristics that influence antibiotic prescribing for adults with nasopharyngitis (common colds), upper respiratory tract infections (URIs) or bronchitis in Taiwan.

Methods. Generalized Estimating Equations (GEE) were used to analyze all 128 260 episodes of common colds, URIs and bronchitis generated by a random sample of 137 935 adult National Health Insurance (NHI) beneficiaries (≥18 years old) in Taiwan in 2000.

Results. Multivariate analysis results revealed substantial variations across different physician groups. Physician age and accreditation level of the physician's practice setting were the characteristics most associated with prescribing of antibiotics at the initial encounters for these episodes of care. Urban practising physicians (adjusted OR 1.69, 95% CI 1.29-2.21) and those who were self-dispensing or with on-site pharmacists (adjusted OR 1.32, 95% CI 1.19-1.46) were also higher prescribers of antibiotics for adults. Other significant physician predictors included physician specialty, patient volume, and ownership of practice setting.

Conclusions. Results suggest that both accessibility to updated medical information and economic incentives of the attending physician may shape prescribing of antibiotics in ambulatory care in Taiwan. Interventions should be developed to influence these modifiable factors to reduce antibiotic prescriptions of questionable value.

Keywords: Adults; antibiotic prescribing; ambulatory care; Taiwan.
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Physicians’ behavior of dispensing and prescribing antibiotics
Chia-Nien Liu, et al.
Family Practice, 7 Oct 2005 [Full text]

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