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Physicians’ behavior of dispensing and prescribing antibiotics
- Chia-Nien Liu, Ming-Chin, Yang (7 October 2005)
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Chia-Nien Liu, Associate Professor of Public Health, National Open University, Taiwan. 104, Ming-Chin, Yang
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A major finding of the article by Huang et al1 reported that physicians who self-dispense medicine were more likely to prescribe antibiotics for adult patients with upper respiratory tract infection (URI), and attributed it as the “financial incentives from the direct link between physicians’ income and the sales of drugs”.We think the attribution is applicable only to a limited number of physicians using itemized forms to claim outpatient care fees. In addition, the article ignored the effects of pharmacists’ double check on antibiotic use by physicians who do not self-dispense medicine. In Taiwan, one thing to be noted, only a few physicians claim outpatient care fees with itemized forms from National health insurance (NHI). These physicians have indeed a greater financial incentive to prescribe more medicine to increase direct income since more prescription almost always means more reimbursement. As a matter of fact, the majority of self-dispensing clinic physicians (treating 76.6％ of the total volume of outpatient visits in Taiwan)2 claim outpatient care fees with simple forms instead of itemized forms and are paid by a fixed amount from NHI. Hence, prescribing more medicine only adds to costs and decreases net income per patient visit. Therefore, attributing the direct link between physicians’ income and the sales of antibiotics does not portray the whole picture of the antibiotic prescribing behavior of physicians. For physicians using simple forms, the financial benefits from using antibiotics are indirect and subject to the influences of culture beliefs, patients’ expectations, clinical uncertainties, and health care system. In Taiwan, antibiotics have been viewed as “antiphlogistics” or “wonder drugs” for many people for many decades, under the impression of their powerful effects for treating bacterial infections in the 20th century3. Up to this day, a number of patients with URI still ask physicians to prescribe antiphlogistics for fast relief of URI symptoms4. Faced with patients’ requests, diagnostic uncertainty about bacterial or viral infections5, and the concern about possible complications, some clinic physicians, who are client-dependent, are very likely to prescribe antibiotics to meet patients’ expectations and, more important, to retain patients1,6. After all, Taiwanese people spend about 14% of total NHI outpatient expenses on outpatient care and average 3.4 outpatient visits per person for colds and influenza every year7. Consequently, curing colds and influenza alone becomes an important source of patients for many clinic physicians. The lack of regular family physicians to offer health education through positive doctor-patient interactions and to play a role of gatekeeper for patients has worsened the situation in Taiwan. Aside from providing up-to-date information to medical professions and separating the dispensing and prescribing of medicine, we suggest that the establishment of a family physician system may be an additional way to improve the antibiotic use. Reference 1.Huang N, Chou YJ, Chang HJ, Ho M, Morlock L. Antibiotic prescribing by ambulatory care physicians for adults with nasopharyngitis, URIs, and acute bronchitis in Taiwan: a multilevel modeling approach. Fam Pract 2005;22:160-167. 2.Huang KH, Lee YC, Huang YT. Impact of separation of drug prescribing and dispensing policy on the release rate of prescriptions from clinics. Taiwan J Public Health 2004;23:469-478. 3.Kunin CM, Lipton HL, Tupasi T, Sacks T, Scheckler WE, Jivani A, et, al. Social, behavioral, and practical factors affecting antibiotic use worldwide: report of task force 4. Rev Infect Dis 1987;9:s270-s285. 4.Lin CC. Antibiotics Prescribing Practice of Office-Based Physicians. Master thesis, Institute of health policy and management, National Taiwan University, 2002. 5.Gonzales R, Corbett K. The culture of antibiotics. Am J Med 1999;107:525-526. 6.Liu CN. A Multilevel Model Analysis of Antibiotic Prescribing Behavior in Upper Respiratory Infections and Acute Bronchitis among Ambulatory Care Physicians. Ph.D. dissertation, Institute of health policy and management, National Taiwan University, 2003. 7.Lin YP, Lew-Ting CY. Outpatient care-seeking of colds and influenza under the health insurance system in Taiwan. Taiwan J Public Health 2003;22:217-226. Conflict of Interest:None declared |
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