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Abstract
This study examined the prescribing of antibiotics and identified the factors, which influence antibiotic prescribing for otitis media in children. It further examined the influence of these drugs on relevant economic outcomes. This study involved analysis of patient records from National Ambulatory Medical Care Survey (NAMCS) 1997.
The decompressed file was imported into Access 97, a relational database package. All the patients with the principal diagnosis of otitis media (ICD-9-CM code 381–382.9) and age less than or equal to 12 years were extracted using the query procedure. The extracted data set, consisting of all otitis media children, as a delimited ASCII file, was imported into STATISTIX R. SpSSR and SASR programs and were used for univariate and multivariate analyses of the data. The average wholesale price of recommended antibiotics was compared with the inappropriate antibiotics prescribed. The cost of the antibiotic was calculated by using the Red Book 1997 and 1998.
The extracted data were analyzed using multiple linear and binomial logit regression models. Examination of the NAMCS 1997 data indicated that the number of different antibiotics prescribed by the physicians is influenced by their specialty. The number of inappropriate antibiotics prescribed to a patient is related to the specialty, and geographic region of the physician and was not influenced by whether another physician referred the patient. Further, the study indicated that the probability of appropriate prescribing was higher for family practice physicians and otolaryngologist than any other specialty.
The difference between a course of less expensive antibiotic and expensive antibiotic was found to be $61.49. Patients who were less than four years of age were prescribed more expensive antibiotics compared to older children. Family practice physicians, pediatricians, and otolaryngologists prescribed cheaper antibiotics than other specialists. There was no relation between the physician's specialty and the age of the patient for inappropriate antibiotics prescribing.
The numbers of diagnostic tests prescribed were not related to patient or physician factors. Avoiding the prescribing of expensive antibiotics or prescribing them in the smallest possible number of prescriptions appears to save money.
