ArticleThe International journal of health planning and management2022
Estimating variations in the use of antibiotics in primary care: Insights from the Tuscany region, Italy.
Article in The International journal of health planning and management, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Observational
- Estimating variations in the use of antibiotics in primary care: Insights from the Tuscany region, Italy.The International journal of health planning and management · 2022Article
- Article
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Authors and funding
3 authors.
Funding
Abstract
backgroundPractice variation is a well-known phenomenon that affects all aspects of healthcare delivery and leads to suboptimal health outcomes as well as poor resource allocation. Given the global rise of antimicrobial resistance, practice variation is of particular concern when it comes to the prescription of antibiotics. A growing number of healthcare systems are tackling this issue at all levels of healthcare governance. AIMS AND
objectivesThis study sought to estimate the variation in antibiotic use across different levels of Tuscany's primary care, and assess the extent to which the organization of primary care delivery is responsible for this variation.
methodsWe analysed the performance and variation for seven indicators related to the use of antibiotics at three levels of healthcare governance: (i) the clinician level (2619 general practitioners [GPs]); (ii) the peer-group level (all 116 GP group practices) and (iii) the institutional level (all 26 health districts). For the statistical analysis, we built three-level mixed effects models that were fitted with 2619 GPs, 116 GP group practices and 26 health districts.
resultsThe multi-level models suggested that the grand majority of the variation in antibiotic use was located at the GP level (75% to 97%). However, the percentage of variation associated with GP group practices and health districts ranged from 3% to 25%, depending on the type of indicator analysed.
conclusionWhile the variation was found to be in large part due to differences between GPs themselves, the influence exerted by peer groups and institutional mechanisms does have a significant impact as well. Further research needs to be conducted regarding the institutional and contextual factors that prompt GPs to harmonize their prescribing behaviour in line with best practices and lead to not only improved patient outcomes but also large cost-savings.
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