Antibiotic prescribing for pediatric respiratory infections: What explains a large variation among physicians?

objectiveTo explore whether there are observable physician characteristics associated with antibiotic prescribing for pediatric respiratory tract infections (RTIs).

designPopulation-based cohort study using a hierarchical generalized linear mixed-model analysis.

settingBritish Columbia.

participantsAll pediatric visits for RTIs between 2005 and 2011.

main outcome measuresThe association between an antibiotic prescription being dispensed within 5 days after each visit and patient, physician, and regional characteristics.

resultsOverall, 27.9% of RTI visits were followed by an antibiotic prescription. After accounting for observed patient, physician, and regional factors, median 2-fold variation was found across physicians in their odds of prescribing. Observable physician characteristics explained nearly half of the variation between them. Higher prescribing was evident among physicians with more years of clinical experience (odds ratio [OR] of 1.46, 95% CI 1.33 to 1.61), international medical graduates (OR = 1.73, 95% CI 1.63 to 1.83), and physicians with proportionally fewer recent visits for RTIs (OR = 1.45, 95% CI 1.38 to 1.52). Female physicians prescribed less often than male physicians did (OR 0.91, 95% CI 0.86 to 0.96).

conclusionSubstantial variations were found among physicians in prescribing antibiotics for pediatric RTIs. Observable characteristics accounted for a meaningful proportion of this variation; however, some physicians have a higher propensity to prescribe than others do, which remains unexplained. Patient and regional characteristics did not explain much of the variation across physicians. In future, behavioural interventions should be designed and evaluated to target physicians with higher propensity to prescribe.