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Rational Prescribing and Interpractitioner Variation: A Multilevel Approach

Published online by Cambridge University Press:  10 March 2009

Peter Davis  and
Barry Gribben
Peter Davis
Affiliation:
University of Auckland School of Medicine
Barry Gribben
Affiliation:
University of Auckland School of Medicine
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Abstract

There are marked geographical variations in rates of medical and surgical intervention at every level of aggregation and in every aspect of medical practice. These data raise a range of important theoretical, methodological, and policy issues. Much the same pattern of variation characterizes the prescription and consumption of therapeutic drugs. Data from a survey of general practice in New Zealand confirm the existence of extensive variability in prescribing. Multilevel techniques are deployed to isolate the specific interpractitioner element in this variability. Controlling for patient, diagnostic, and practitioner variables improves the predictive power of the model but does not reduce the extent of interpractitioner variability in prescribing rates. The existence of such variability raises questions about the role of clinical uncertainty and professional autonomy in the promotion of rational therapeutics in medical practice.

Type
Special Section: The Rational Use of Therapeutic Drugs
Information
International Journal of Technology Assessment in Health Care , Volume 11 , Issue 3 , Summer 1995 , pp. 428 - 442
Copyright
Copyright © Cambridge University Press 1995

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