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Antibiotic prescribing decreases when patient, doctor are both women
Female general practitioners in the Netherlands prescribed antibiotics less often than their male counterparts, according to findings published in BMC Family Practice.
“Female gender concordance is associated with more effective treatment of cardiovascular risks and male gender concordance is positively associated with measures on diet, nutrition and exercise counseling. It is however not known whether gender concordance influences prescribing behavior of antibiotics,” D. Eggermont, of the department of public health, Amsterdam UMC, University of Amsterdam, and colleagues wrote.
“Possibly, concordance is an additional nonmedical factor that affects (inappropriate) antibiotics prescription. Creating awareness of such nonmedical factors could result in [general practitioners] being less biased, more objective and consistent in their treatments,” they added.
Researchers studied prescribing behavior among 225 general practitioners — 47.9% of them female — in 22,412 adult patient consultations that involved sore throat symptoms.
Eggermont and colleagues found that among female general practitioners, gender concordance was associated with reduced antibiotics prescribing (OR = 0.85; 95% CI, 0.72-0.99). Overall antibiotic prescribing was lower among female general practitioners (OR = 0.88; 95% CI, 0.67-1.09) and female patients were less likely to receive an antibiotic (OR = 0.93; 95% CI, 0.84-1.02) but the differences were not statistically significant. The difference in prescription rates by gender concordance was also not statistically significant in all general practice consultations (OR = 0.92; 95% CI, 0.82-1.02), nonprotocolled consultations (OR = 0.92; 95% CI, 0.83-1.01), and protocolled consultations (OR = 1; 95% CI, 0.68-1.32).
“The results of this study suggest that this feminization could lead to a reduction in the prescription of antibiotics. Female concordance enhances patient-centered communication and this might be the underlying explanation for our findings. If so, our results underline the importance of effective communication styles, both by male and female general practitioners, to contain the prescription of antibiotics,” Eggermont and colleagues wrote. They added future studies should use their results to ascertain if the training provided to female general practitioners regarding patient communications needs to be revised. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.
Perspective
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There have been several studies looking at physician gender and how that might impact quality of care. For example, Adams et al, evaluated gender related to diagnosing heart disease. Berthold and colleagues evaluated diabetes, while Dahrouge et al, evaluated family practice. Eggermont and colleagues’ analysis evaluated not only physician gender but concordance of gender with patients and the effect on antibiotic prescribing.
At first glance, it is somewhat concerning to see disparity in care by gender. But Eggermont et al, postulate that there are unique factors associated with gender concordance and discordance in the physician-patient relationship, and that female doctors have more patient-centered encounters, and perhaps combining that with female patients may lead to a more patient centric outcome of less antibiotics prescribed. Eggermont and colleagues’ data is contrary to many physician perceptions that patients want an antibiotic or a prescription at each encounter and can be helpful to educate physicians on managing patient expectations. Evaluating more patient-centered techniques and how those can be effective in discordant gender relationships may help all physicians improve antibiotic prescribing. There may also be some sampling bias; the male physicians in the sample were older age and there is data from other studies that show that older physicians are more likely to prescribe antibiotics than younger physicians.
Further work should be done to improve the communication strategies used by these physicians. It may help us train our physicians to be better communicators and might help other patient, work and social encounters with discordant gender relationships.