Predictors of the prescription of antibiotics by Flemish GPs in adult acute cough patients. Figures are numbers (%) unless stated otherwise.a
| Prescribed antibiotics (n = 500)a | Not prescribed antibiotics (n = 948)a | Crude OR (95% Cl)b (n=1448) | Significance | Adjusted ORc (95% Cl)b (n=819) | Significance | |
|---|---|---|---|---|---|---|
| Demographics | ||||||
| Mean age in years (SD) | 42.05 (13.03) | 40.23 (13.05) | 1.01 (1.00 to 1.02) | † | 1.02 (1.00 to 1.04) | |
| Comorbidity and risk | ||||||
| COPD | 54/493 (11) | 57/930 (6) | 2.39(1.57 to 3.64) | † | 0.77(0.35 to 1.69) | |
| ACE inhibitor | 17/490 (3) | 18/926 (2) | 2.13 (1.01 to 4.49) | † | 1.05 (0.26 to 4.19) | |
| Aspiration risk | 6/488 (1) | 8/925 (1) | 2.85 (1.87 to 4.34) | † | 14.79 (1.24 to 176.71) | † |
| Smoking | 183/499 (37) | 281/944 (30) | 1.56 (1.25 to 1.95) | † | 1.00 (0.59 to 1.68) | |
| Circumstances | ||||||
| Impression of sickness: ill | 295/480 (61) | 319/901 (35) | 3.04 (2.29 to 4.04) | † | 2.28 (1.47 to 3.53) | † |
| Demand for antibiotics | 125/500 (25) | 93/948 (10) | 4.64 (2.96 to 7.26) | † | 20.83 (8.86 to 48.99) | † |
| Symptoms | ||||||
| Mean (SD) duration of coughing (days) | 6.45 (5.04) | 5.35 (4.73) | 1.05 (1.03 to 1.07) | † | 1.04 (0.99 to 1.10) | |
| Sputum | 374/500 (75) | 458/942 (49) | 3.04 (2.32 to 3.97) | † | 2.52 (1.62 to 3.92) | † |
| Fever | 166/500 (33) | 243/943 (26) | 1.49 (1.17 to 1.89) | † | 1.11 (0.67 to 1.83) | |
| Headache | 281/492 (57) | 446/923 (48) | 1.38 (1.12 to 1.71) | † | 1.57 (1.03 to 2.37) | † |
| Muscle ache | 175/486 (36) | 301/925 (33) | 1.27 (1.01 to 1.59) | † | 0.75 (0.48 to 1.17) | |
| Wheezing | 138/487 (28) | 136/929 (15) | 2.34 (1.78 to 3.07) | † | 0.63 (0.34 to 1.17) | |
| Short of breath | 185/487 (38) | 216/927 (23) | 2.38 (1.85 to 3.05) | † | 1.27 (0.68 to 2.37) | |
| Chest pain | 215/489 (44) | 263/922 (29) | 2.02 (1.61 to 2.52) | † | 1.68 (1.07 to 2.65) | † |
| Loss of appetite | 164/482 (34) | 194/901 (22) | 2.20 (1.69 to 2.87) | † | 1.22 (0.74 to 2.02) | |
| Limited activity | 255/488 (52) | 374/915 (41) | 1.92 (1.47 to 2.52) | † | 1.73 (0.87 to 3.42) | |
| Signs | ||||||
| ‘Higher risk’ | 212/500 (42) | 323/948 (34) | 1.38 (1.11 to 1.71) | † | 1.21 (0.78 to 1.87) | |
| Mean (SD) number of abnormal auscultatory findings | 1.01 (1.09) | 0.36 (0.75) | 2.53 (2.02 to 3.18) | † | 3.04 (2.03 to 4.54) | † |
| Percussion dullness | 9/473 (2) | 6/889 (1) | 6.15 (0.71 to 53.21) | 1.46 (0.15 to 13.80) | ||
| Prescriptions | ||||||
| Referral | 13/496 (3) | 21/932 (2) | 1.71 (0.98 to 3.00) | 0.04 (0.01 to 0.14) | † | |
| Follow-up contact | 69/479 (14) | 68/880 (8) | 3.06 (1.99 to 4.69) | † | 2.18 (0.81 to 5.85) | |
| GPs' characteristics | ||||||
| Professional training | 111/456 (24) | 259/890 (29) | 0.85 (0.56 to 1.29) | 0.20 (0.10 to 0.42) | † | |
| Fee for service | 497/500 (99) | 926/948 (98) | 4.06 (2.64 to 6.23) | † | 1.63 (0.10 to 26.09) | |
| Part-time | 59/489 (12) | 198/333 (21) | 0.52 (0.32 to 0.86) | † | 1.35 (0.35 to 5.16) | |
| Province | ||||||
| Antwerp | 269 (54) | 670 (71) | 1 | 1 | ||
| Brussels | 41 (8) | 28 (3) | 3.38 (1.16 to 9.84) | † | 29.20 (4.85 to 176.71) | † |
| Limburg | 35 (7) | 37 (4) | 2.24 (0.86 to 5.89) | 2.75 (0.88 to 8.63) | ||
| West Flanders | 98 (20) | 93 (10) | 2.07 (1.25 to 3.43) | † | 3.95 (1.60 to 9.76) | † |
| East Flanders | 57 (11) | 120 (13) | 1.12 (0.60 to 2.11) | 1.88 (0.37 to 9.50) | ||
| Spirometer | 93/500 (19) | 303/948 (32) | 0.61 (0.37 to 0.99) | † | 0.44 (0.21 to 0.90) | † |
| Year of birth | 55.99 (7.64) | 55.56 (8.39) | 1.01 (0.99 to 1.03) | 1.22 (1.01 to 1.47) | † | |
| Mean (SD) number of patient encounters per week | 112.14 (46.08) | 101.06 (40.08) | 1.01 (1.00 to 1.01) | † | 1.00 (0.99 to 1.02) | |
| Mean (SD) number of home visits per week | 38.63 (18.80) | 30.53 (17.41) | 1.02 (1.01 to 1.03) | † | 1.03 (1.00 to 1.06) | |
| Mean (SD) ATC J cost ratio | 16.54 (6.64) | 14.28 (6.23) | 1.05 (1.02 to 1.08) | † | 0.94 (0.84 to 1.06) | |
| Mean (SD) ATC J volume ratio | 3.60 (1.44) | 2.91 (1.28) | 1.35 (1.19 to 1.53) | † | 1.58 (0.97 to 2.57) | |
| Design | ||||||
| Registration year: 2001 | 190/500 (38) | 481/948 (51) | 0.64 (0.52 to 0.80) | † | 0.74 (0.42 to 1.28) | |
| Year*group: 2001*intervention | 78/190 (41) | 206/481 (43) | 0.57 (0.40 to 0.82) | † | 0.72 (0.23 to 2.29) | |
| Interaction terms of final model | ||||||
| Demand for antibiotics*number of abnormal auscultatory findings | 1.76 (1.30 to 2.38) | 0.23 (0.13 to 0.41) | ||||
| GP's sex*year of birth | 1.01 (1.00 to 1.01) | 0.90 (0.76 to 1.06) | ||||