Background
Methods
Study design
Setting and participants
Prescribing indicators
Field work
Statistical analyses
Results
Demographics of the GPs and characteristics of the encounters
Demographics of the GPs | n (percentage) |
---|---|
Gender | |
Male | 32 (37.6%) |
Female | 53 (62.4%) |
Age group | |
≤ 35 years old | 19 (22.4%) |
36–45 years old | 51 (60.0%) |
≥ 46 years old | 15 (17.6%) |
Work experience | |
5–10 years | 10 (11.8%) |
11–20 years | 34 (40.0%) |
> 20 years | 41 (48.2%) |
Encounter characteristics | n (percentage) |
---|---|
Gender | |
Male | 4046 (47.6%) |
Female | 4436 (52.2%) |
Missing | 18 (0.2%) |
Age group | |
0–24 years old | 355 (4.2%) |
25–44 years old | 1551 (18.2%) |
45–59 years old | 3095 (36.4%) |
≥ 60 years old | 3456 (40.7%) |
Missing | 43 (0.5%) |
Reason for encounter | |
Present with at least one symptom | 4920 (57.9%) |
Regular follow up | 769 (9.0%) |
Prescription refill without other complaint | 2513 (29.6%) |
Other reasons | 298 (3.5%) |
Insurance type | |
PIIS | 2111 (24.8%) |
EBMS | 2096 (24.7%) |
NRCMS | 3463 (40.7%) |
Other insurance | 300 (3.5%) |
No insurance | 431 (5.1%) |
Missing | 99 (1.2%) |
First time visit | |
Yes | 521 (6.1%) |
No | 7750 (91.2%) |
Missing | 229 (2.7%) |
Contracted patient | |
Yes | 5167 (60.8%) |
No | 3074 (36.2%) |
Missing | 259 (3.0%) |
Chronic disease | |
Yes | 4902 (57.7%) |
No | 3598 (42.3%) |
Number of problems discussed | |
< 3 | 7323 (86.2%) |
≥ 3 | 1177 (13.8%) |
Consultation time | |
< 5 min | 2774 (32.6%) |
5–10 min | 3778 (44.4%) |
> 10 min | 1721 (20.3%) |
Missing | 227 (2.7%) |
Prescribing indicators of the encounters
Prescribing indicators assessed | Total medicines/encounters | Median (interquartile range)/percentage |
---|---|---|
Median number of medicines per encounter | 16,067 | 2.0 (1.0, 2.0) |
Percentage of encounters with antibiotics prescribed | 1285 | 15.1% |
Percentage of encounters with injections prescribed | 312 | 3.7% |
Percentage of medicines prescribed by generic name | 15,577 | 97.0% |
Percentage of medicines from EML | 9343 | 58.2% |
Percentage of encounters with TCPMs prescribed | 4459 | 52.5% |
Median duration of consultation time (minutes) | 8273 | 6.0 (4.0, 10.0) |
Rank | Medicine | Frequency | Percentage in all medicines | Whether or not EML | Whether or not TCPM |
---|---|---|---|---|---|
1 | Aspirin (low dose) | 739 | 4.6% | Yes | No |
2 | Ganmaoqingre (mainly for common cold) | 517 | 3.2% | Yes | Yes |
3 | Nifedipine | 502 | 3.1% | Yes | No |
4 | Cefuroxime | 422 | 2.6% | Yes | No |
5 | Amlodipine | 410 | 2.6% | Yes | No |
6 | Acarbose | 302 | 1.9% | Yes | No |
7 | Metformin | 296 | 1.8% | Yes | No |
8 | Levofloxacin | 278 | 1.7% | Yes | No |
9 | Ambroxol | 271 | 1.7% | Yes | No |
10 | Qingkailing (mainly for common cold) | 258 | 1.6% | Yes | Yes |
Prescribing patterns of the GPs
Demographics of the GPs | Median medicines per encounter (interquartile range) | Percentage of encounters with generic medicines | Percentage of encounters with antibiotics | Percentage of encounters with injections | Percentage of encounters with essential medicines | Percentage of encounters with TCPMs |
---|---|---|---|---|---|---|
Gender | ||||||
Male | 2.0 (1.0, 2.0) | 90.9% | 14.9% | 2.0% | 68.0% | 49.8% |
Female | 2.0 (1.0, 3.0) | 91.6% | 15.3% | 4.7% | 72.0% | 54.1% |
Z or χ2 | −7.902 | 1.187 | 0.235 | 40.508 | 15.586 | 14.411 |
P value |
0.000
*
| 0.276 | 0.627 |
0.000
*
|
0.000
*
|
0.000
*
|
Age group | ||||||
≤ 35 years old | 2.0 (1.0, 2.0) | 90.7% | 14.0% | 1.9% | 63.4% | 49.7% |
36–45 years old | 2.0 (1.0, 3.0) | 91.5% | 15.0% | 4.0% | 72.9% | 53.4% |
≥ 46 years old | 2.0 (1.0, 2.0) | 91.6% | 16.8% | 4.8% | 71.2% | 52.8% |
χ2 | 55.963 | 1.440 | 5.182 | 23.923 | 61.174 | 7.716 |
P value |
0.000
*
| 0.487 | 0.075 |
0.000
*
|
0.000
*
|
0.021
*
|
Work experience | ||||||
5–10 years | 2.0 (1.0, 2.0) | 90.3% | 13.3% | 0.7% | 64.1% | 51.8% |
11–20 years | 2.0 (1.0, 2.0) | 90.8% | 16.1% | 4.4% | 71.3% | 52.1% |
> 20 years | 2.0 (1.0, 2.0) | 92.1% | 14.8% | 3.8% | 71.4% | 52.9% |
χ2 | 17.443 | 5.631 | 5.488 | 30.037 | 22.204 | 0.721 |
P value |
0.000
*
| 0.060 | 0.064 |
0.000
*
|
0.000
*
| 0.697 |
The influence of encounter characteristics on prescribing indicators
Encounter characteristics | Median medicines per encounter (interquartile range) | Percentage of encounters with generic medicines | Percentage of encounters with antibiotics | Percentage of encounters with injections | Percentage of encounters with essential medicines | Percentage of encounters with TCPMs |
---|---|---|---|---|---|---|
Gender | ||||||
Male | 2.0 (1.0, 3.0) | 91.4% | 15.1% | 4.2% | 71.6% | 51.4% |
Female | 2.0 (1.0, 2.0) | 91.1% | 15.2% | 3.2% | 69.5% | 53.4% |
Missing | 18 | |||||
Z or χ2 | −1.743 | 0.008 | 0.023 | 5.705 | 4.296 | 3.539 |
P value | 0.081 | 0.928 | 0.880 |
0.017
*
|
0.038
*
| 0.060 |
Age group | ||||||
0–14 | 2.0 (1.0, 2.0) | 85.9% | 32.4% | 5.9% | 55.3% | 63.5% |
15–24 | 2.0 (1.0, 2.0) | 87.6% | 33.0% | 7.6% | 69.7% | 62.2% |
25–44 | 2.0 (1.0, 2.0) | 89.9% | 23.2% | 3.7% | 67.6% | 62.7% |
45–59 | 2.0 (1.0, 2.0) | 91.1% | 13.5% | 2.9% | 69.2% | 51.3% |
≥ 60 | 2.0 (1.0, 3.0) | 92.8% | 11.2% | 4.1% | 73.9% | 47.8% |
Missing | 43 | |||||
χ2 | 12.549 | 22.742 | 211.431 | 17.435 | 47.095 | 112.701 |
P value |
0.014
*
|
0.000
*
|
0.000
*
|
0.002
*
|
0.000
*
|
0.000
*
|
Reason for encounter | ||||||
Present with at least one symptom | 2.0 (1.0, 3.0) | 92.3% | 22.9% | 4.9% | 69.1% | 67.1% |
Regular follow up | 1.0 (1.0, 2.0) | 93.9% | 3.9% | 2.7% | 70.2% | 23.4% |
Prescription refill without other complaint | 2.0 (1.0, 2.0) | 97.0% | 4.3% | 1.5% | 79.8% | 38.0% |
Other reasons | 0 (0, 0) | 22.1% | 6.7% | 5.0% | 15.4% | 7.0% |
χ2 | 613.625 | 1921.523 | 553.674 | 57.440 | 544.088 | 1139.777 |
P value |
0.000
*
|
0.000
*
|
0.000
*
|
0.000
*
|
0.000
*
|
0.000
*
|
Insurance type | ||||||
PIIS | 2.0 (1.0, 3.0) | 94.5% | 16.6% | 2.8% | 75.5% | 58.6% |
EBMS | 2.0 (1.0, 3.0) | 94.2% | 14.1% | 3.1% | 71.3% | 59.2% |
NRCMS | 2.0 (1.0, 2.0) | 88.9% | 13.6% | 4.0% | 68.1% | 44.3% |
Other insurance | 2.0 (1.0, 3.0) | 93.3% | 17.3% | 3.7% | 68.7% | 57.3% |
No insurance | 2.0 (1.0, 2.0) | 81.9% | 23.2% | 8.1% | 62.6% | 52.4% |
Missing | 99 | |||||
χ2 | 116.527 | 124.972 | 34.935 | 31.825 | 49.315 | 164.359 |
P value |
0.000
*
|
0.000
*
|
0.000
*
|
0.000
*
|
0.000
*
|
0.000
*
|
First time visit | ||||||
Yes | 2.0 (1.0, 2.0) | 81.8% | 22.3% | 6.0% | 59.1% | 52.8% |
No | 2.0 (1.0, 2.0) | 92.0% | 14.7% | 3.5% | 71.1% | 52.5% |
Missing | 229 | |||||
Z or χ2 | −4.823 | 64.990 | 21.901 | 8.014 | 33.663 | 0.020 |
P value |
0.000
*
|
0.000
*
|
0.000
*
|
0.005
*
|
0.000
*
| 0.888 |
Contracted patient | ||||||
Yes | 2.0 (1.0, 3.0) | 92.4% | 12.6% | 3.3% | 72.6% | 50.2% |
No | 2.0 (1.0, 2.0) | 89.6% | 19.2% | 4.3% | 66.7% | 56.1% |
Missing | 259 | |||||
Z or χ2 | −6.092 | 20.185 | 65.265 | 5.847 | 32.177 | 26.959 |
P value |
0.000
*
|
0.000
*
|
0.000
*
|
0.016
*
|
0.000
*
|
0.000
*
|
Chronic disease | ||||||
Yes | 2.0 (1.0, 3.0) | 93.2% | 9.3% | 3.1% | 75.3% | 43.3% |
No | 2.0 (1.0, 2.0) | 88.8% | 23.0% | 4.4% | 63.9% | 65.0% |
Z or χ2 | −7.330 | 52.042 | 305.195 | 9.166 | 128.968 | 395.725 |
P value |
0.000
*
|
0.000
*
|
0.000
*
|
0.002
*
|
0.000
*
|
0.000
*
|
Number of problems involved | ||||||
< 3 | 2.0 (1.0, 2.0) | 90.5% | 14.0% | 3.8% | 68.1% | 49.8% |
≥ 3 | 3.0 (2.0, 4.0) | 96.8% | 22.3% | 3.1% | 85.0% | 69.0% |
Z or χ2 | −29.714 | 50.620 | 54.311 | 1.447 | 139.293 | 149.682 |
P value |
0.000
*
|
0.000
*
|
0.000
*
| 0.229 |
0.000
*
|
0.000
*
|
Consultation time | ||||||
< 5 min | 2.0 (1.0, 2.0) | 85.9% | 13.6% | 4.4% | 64.2% | 48.6% |
5–10 min | 2.0 (1.0, 3.0) | 93.9% | 15.9% | 3.5% | 75.6% | 54.9% |
> 10 min | 2.0 (1.0, 3.0) | 95.3% | 17.0% | 3.2% | 71.3% | 54.7% |
Missing | 227 | |||||
χ2 | 160.473 | 171.193 | 11.100 | 5.549 | 99.659 | 28.615 |
P value |
0.000
*
|
0.000
*
|
0.004
*
| 0.062 |
0.000
*
|
0.000
*
|
Encounter characteristics | Prescription of ≥3 medicines in the encounter | Prescription of generic medicines in the encounter | Prescription of antibiotics in the encounter | Prescription of injections in the encounter | Prescription of essential medicines in the encounter | Prescription of TCPMs in the encounter | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Adjusted OR (95% CI) | P | Adjusted OR (95% CI) | P | Adjusted OR (95% CI) | P | Adjusted OR (95% CI) | P | Adjusted OR (95% CI) | P | Adjusted OR (95% CI) | P | |
Gender | ||||||||||||
Female (ref) | ||||||||||||
Male |
1.138 (1.017, 1.274)
|
0.025
*
| 1.001 (0.830, 1.205) | 0.996 | 1.078 (0.946, 1.228) | 0.259 |
1.331 (1.049, 1.688)
|
0.019
*
| 1.058 (0.954, 1.173) | 0.283 | 0.963 (0.872, 1.064) | 0.459 |
Age group | ||||||||||||
0–14 (ref) | ||||||||||||
15–24 | 0.879 (0.516, 1.498) | 0.636 | 1.369 (0.645, 2.903) | 0.413 | 0.824 (0.512, 1.327) | 0.425 | 0.963 (0.405, 2.292) | 0.932 |
1.771
(1.097, 2.859)
|
0.019
*
| 0.809 (0.496, 1.319) | 0.395 |
25–44 |
0.647
(0.428, 0.979)
|
0.039
*
| 1.065 (0.592, 1.914) | 0.834 |
0.608
(0.419, 0.882)
|
0.009
*
| 0.642 (0.314, 1.312) | 0.224 | 1.319 (0.919, 1.893) | 0.133 | 0.839 (0.573, 1.227) | 0.365 |
45–59 |
0.649
(0.431, 0.977)
|
0.038
*
| 1.039 (0.581, 1.856) | 0.898 |
0.479
(0.330, 0.695)
|
0.000
*
| 0.655 (0.323, 1.329) | 0.241 | 1.191 (0.833, 1.702) | 0.337 | 0.859 (0.590, 1.252) | 0.429 |
≥ 60 |
0.615
(0.407, 0.931)
|
0.021
*
| 1.193 (0.661, 2.153) | 0.559 |
0.464
(0.317, 0.677)
|
0.000
*
| 1.103 (0.545, 2.235) | 0.785 | 1.321 (0.920, 1.895) | 0.131 | 0.830 (0.568, 1.213) | 0.336 |
Reason for encounter | ||||||||||||
Present with at least one symptom (ref) | ||||||||||||
Regular follow up |
0.544
(0.430, 0.690)
|
0.000
*
| 1.391 (0.958, 2.019) | 0.082 |
0.236
(0.160, 0.348)
|
0.000
*
|
0.477
(0.289, 0.785)
|
0.004
*
| 0.960 (0.794, 1.160) | 0.672 |
0.222
(0.182, 0.270)
|
0.000
*
|
Prescription refill without other complaint | 0.926 (0.805, 1.065) | 0.281 |
2.948
(2.215, 3.923)
|
0.000
*
|
0.212
(0.169, 0.265)
|
0.000
*
|
0.222
(0.150, 0.328)
|
0.000
*
|
1.754
(1.529, 2.012)
|
0.000
*
|
0.366
(0.324, 0.413)
|
0.000
*
|
Other reasons |
0.144
(0.075, 0.274)
|
0.000
*
|
0.033
(0.024, 0.045)
|
0.000
*
|
0.277
(0.173, 0.443)
|
0.000
*
| 0.767 (0.441, 1.336) | 0.350 |
0.096
(0.068, 0.135)
|
0.000
*
|
0.042
(0.026, 0.066)
|
0.000
*
|
Insurance type | ||||||||||||
PIIS (ref) | ||||||||||||
EBMS |
1.279
(1.099, 1.489)
|
0.002
*
| 1.158 (0.855, 1.567)) | 0.343 | 0.960 (0.801, 1.150) | 0.657 | 1.173 (0.808, 1.704) | 0.402 | 0.870 (0.751, 1.008) | 0.064 |
1.201
(1.045, 1.380)
|
0.010
*
|
NRCMS |
0.865
(0.749, 1.000)
|
0.049
*
|
0.553
(0.429, 0.713)
|
0.000
*
| 0.963 (0.816, 1.137) | 0.659 |
1.551
(1.119, 2.149)
|
0.008
*
|
0.812
(0.710, 0.928)
|
0.002
*
|
0.631
(0.556, 0.716)
|
0.000
*
|
Other insurance | 1.092 (0.797, 1.498) | 0.583 | 0.864 (0.484, 1.542) | 0.620 | 0.905 (0.635, 1.290) | 0.583 | 1.392 (0.712, 2.724) | 0.334 | 0.831 (0.622, 1.112) | 0.213 | 0.899 (0.675, 1.196) | 0.464 |
No insurance | 1.011 (0.757, 1.351) | 0.939 |
0.511
(0.343, 0.763)
|
0.001
*
| 0.936 (0.703, 1.246) | 0.650 |
2.470
(1.510, 4.040)
|
0.000
*
| 0.907 (0.702, 1.171) | 0.452 |
0.626
(0.488, 0.803)
|
0.000
*
|
First time visit | ||||||||||||
No (ref) | ||||||||||||
Yes | 0.945 (0.730, 1.223) | 0.666 |
0.523
(0.378, 0.723)
|
0.000
*
| 1.048 (0.820, 1.341) | 0.707 | 1.238 (0.798, 1.921) | 0.341 | 0.808 (0.651, 1.003) | 0.053 |
0.693
(0.557, 0.861)
|
0.001
*
|
Contracted patient | ||||||||||||
No (ref) | ||||||||||||
Yes |
1.159
(1.019, 1.320)
|
0.025
*
| 0.989 (0.802, 1.218) | 0.916 | 0.885 (0.766, 1.022) | 0.097 | 0.852 (0.652, 1.114) | 0.241 | 1.040 (0.927, 1.168) | 0.502 | 0.994 (0.889, 1.113) | 0.923 |
Chronic disease | ||||||||||||
No (ref) | ||||||||||||
Yes | 0.963 (0.832, 1.116) | 0.620 | 1.076 (0.853, 1.357) | 0.536 |
0.455
(0.382, 0.542)
|
0.000
*
| 1.215 (0.901, 1.640) | 0.202 |
1.296
(1.138, 1.475)
|
0.000
*
|
0.449
(0.396, 0.508)
|
0.000
*
|
Number of problems involved | ||||||||||||
< 3(ref) | ||||||||||||
≥ 3 |
6.753
(5.806, 7.853)
|
0.000
*
|
2.074
(1.398, 3.077)
|
0.000
*
|
2.875
(2.361, 3.499)
|
0.000
*
| 0.773 (0.522, 1.145) | 0.199 |
2.089
(1.731, 2.520)
|
0.000
*
|
2.926
(2.511, 3.410)
|
0.000
*
|
Consultation time | ||||||||||||
< 5 min (ref) | ||||||||||||
5–10 min |
1.537
(1.347, 1.755)
|
0.000
*
|
2.271
(1.848, 2.790)
|
0.000
*
| 0.950 (0.814, 1.110) | 0.518 |
0.701
(0.536, 0.917)
|
0.009
*
|
1.630
(1.447, 1.836)
|
0.000
*
| 1.016 (0.905, 1.139) | 0.792 |
> 10 min | 0.981 (0.827, 1.163) | 0.826 |
2.809
(2.127, 3.711)
|
0.000
*
| 0.858 (0.713, 1.031) | 0.102 |
0.562
(0.398, 0.792)
|
0.001
*
|
1.367
(1.182, 1.579)
|
0.000
*
|
0.819
(0.710, 0.945)
|
0.006
*
|