Managed Care and URIs
Physicians may prescribe antibiotics for more than 60% of patients with colds or acute bronchitis, though supportive evidence for this practice is scant. Based upon the hypothesis that physicians practicing in staff model HMOs would be more prudent with their prescribing practices for URIs and bronchitis than are traditional fee-for-service physicians, a study was done by retrospective chart review of 660 patients who were coded as suffering from URI or acute bronchitis; excluded were patients with concomitant maladies for which antibiotics are more routinely considered appropriate (e.g., otitis media, streptococcal pharyngitis).
Antibiotics were prescribed more than 1.5 times more often by HMO physicians for URIs. For acute bronchitis, HMO physicians prescribed antibiotics in 82% of cases vs. 73% by fee-for-service physicians. After adjusting for such variables as site of care, physician specialty, and patient age, the odds ratio for receiving antibiotics for URIs was 2.35 for HMO physicians compared to fee-for-service physicians. For acute bronchitis, the l.73 odds ratio did not achieve statistical significance (P = 0.14).
There was no significant difference between the groups in likelihood of returning with respiratory complaints within the next 30 days, whether the patient had been seen for URI or acute bronchitis. The fee-for-service physicians ordered a significantly larger number of tests. The authors comment that these data suggest that though managed care has been successful in limiting diagnostic tests (and its attendant expense), they have not reduced the rate of prescribing of antibiotics for unindicated reasons.
Hueston W. J Fam Pract 1997;44: 572-577.
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