Abstract
Introduction: Variation in practice patterns among physicians is well-documented despite professional guidelines and increasingly uniform medical training. Variations may lead to improper utilization of healthcare resources, misdiagnosis, overdiagnosis, unnecessary treatments, and forgoing of needed interventions. One area of clinical variation and overuse of particular interest is the prescribing of antibiotics, which can lead to eventual antibiotic resistance and other negative consequences. Variations in antibiotic prescribing along with other practice patterns have been studied previously but no attempt has been made to examine the correlation between multiple practice patterns. The purpose of this study was to determine if a correlation existed between the provider behaviors studied.Methods: A small area network of 39 pediatric providers was analyzed to determine if antibiotic prescription percentages varied. Antibiotic prescription percentages were further broken down by visit type (sick versus well). Two other practice measures, in-office lab utilization and diagnoses of food and drug allergies, were then analyzed. Data were explored primarily with Spearman’s correlation tests.Results: Strong positive correlation was seen between a provider's antibiotic prescription percentage at sick and well visits. Strong positive correlation was seen between the antibiotic prescribing percentage and the number of in-office labs ordered. Moderate positive correlation was seen between antibiotic prescribing percentage and the percentage of a provider’s empaneled patients with any allergy diagnosis (medication, food, or seasonal).Conclusion: This retrospective study demonstrates that variation in provider practice patterns continues to exist despite established practice guidelines from national organizations. It also demonstrates a linear correlation between multiple provider behaviors that have not previously been explored together. The presence of a correlation between clinical behaviors may suggest an underlying practice philosophy and present an opportunity for personalized, provider-specific education and quality improvement.
Highlights
Variation in practice patterns among physicians is well-documented despite professional guidelines and increasingly uniform medical training
Strong positive correlation was seen between a provider's antibiotic prescription percentage at sick and well visits
Strong positive correlation was seen between the antibiotic prescribing percentage and the number of in-office labs ordered
Summary
Variation in practice patterns among physicians is well-documented despite professional guidelines and increasingly uniform medical training. A more recent study has shown that despite more uniform and advanced medical training and professional guidelines, variations still exist [4]. These variations affect the quality of care and contribute to healthcare disparity, especially when they lead to the overuse of diagnostic tools and treatment. Overdiagnosis is considered to occur when people are labeled with or treated for a disease that would never cause them harm [5] This often results from unnecessary screening and can lead to the overuse of additional tests and treatments. Potential causes include the expansion of disease definitions (allowing more people to be labeled as “sick”), financial incentives within the hospital system, defensive medicine from fear of litigation, and the influence of increasingly sensitive tests that lead to the detection of minor abnormalities [5]
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