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Doctor characteristics and prescribing antibiotics for urinary tract infections: the experience of an Asian country.

RATIONALE, AIMS AND OBJECTIVES
This study aims to explore the relationship between doctor characteristics and prescribing behaviour for patients with urinary tract infections (UTIs) using a 2-year population-based data set in Taiwan.


METHODS
This study used data from the Taiwan National Health Insurance Research Database. Our study sample consists of first-time ambulatory care visits for treatment of UTIs among female patients between 2005 and 2006 (n=45,934). The primary outcome studied was 'whether a broad-spectrum antibiotic was prescribed', and the key independent variables were 'doctor characteristics'. Doctor characteristics included gender, age (<41, 41-50, >50), specialty, type (hospital-based vs. office-based) and practice location. Multivariate logistic regression analysis using generalized estimated equations was performed to assess the adjusted odds ratio of the doctors using broad-spectrum antibiotics.


RESULTS
Among the sampled patients, 13.5% were prescribed broad-spectrum antibiotics at their first visit for treatment of UTIs. The adjusted odds of prescribing second-line antibiotics for doctors aged between 41-50 years and >50 years were 0.80 (P<0.001) and 0.90 (P=0.007) times, respectively, that of doctors aged <41 years. Doctors specializing in family medicine were 1.10 (P=0.006) times more likely than doctors specializing in obstetrics and gynaecology to prescribe broad-spectrum, and office-based doctors were 1.41 (P<0.001) times more likely than hospital-based doctors to do so.


CONCLUSIONS
We conclude that there is variation in doctor prescribing behaviour of antimicrobial therapy for UTIs, after adjusting for possible confounding factors. Continuing medical education and intervention should be designed for doctor groups with undesirable performance in prescribing antibiotics.