Summary of results
In this study, we assessed whether gender concordance between GP and patient was associated with antibiotics prescribing. Gender concordance among females is associated with less prescription of antibiotics, i.e. female GPs appear to issue fewer antibiotics prescriptions to female patients than to male patients. Concordance appears not to have a similar effect in prescribing behavior of male GPs. For both concordant dyads combined, prescription rates were lower than for discordant dyads, but this difference was not statistically significant. Whether the treatment was protocolled did not appear to affect these findings.
Interpretation of results
When a patient with sore throat symptoms presents him- or herself in a primary care facility, infection is usually the underlying cause . For these symptoms, physicians can send their patient home for a ‘wait and see’ policy or they can prescribe antibiotics. The results of this study indicate that female physicians are more likely to apply a wait and see policy when seeing a female patient in comparison with the other gender dyads.
Female concordance has been associated with a communication style that is more patient centered [17, 18]. Patient centered communication enhances health outcomes by elevated patients’ trust, improved communication and patient satisfaction [17,18,19,20, 29]. When communication is patient centered, the physician focuses at hearing and understanding the patients’ perspectives. For this, the physician needs to explore the patients ideas and concerns as well as their expectations regarding the physician . It has been shown that addressing patients’ ideas, concerns and expectations during a consultation, known as the ICE-model, might lead to fewer medication prescriptions . This is potentially important because a wait and see policy is easier to adopt when patients feel being heard.
In our study, 27.6% of all patients got prescribed antibiotics for their sore throat complaints. This is low in comparison to other countries. In the UK, for example, approximately 56% of all patients with sore throat complaints receive antibiotics from their GP . Traditionally, antibiotic prescription in the Netherlands is lowest of all European countries, with differences up to a threefold . It is unclear how this relates to the outcomes of our study. Therefore, generalizing our findings to countries with much higher antibiotic prescription rate should be done with caution.
Patient age and comorbidity were identified as being predictive for prescribing antibiotics. This was in line with previous research which showed age to be a determinant in the prescription of antibiotics for lower respiratory tract infections and that antibiotics are more often prescribed for patients with comorbidity such as diabetes or chronic obstructive pulmonary disease .
Limitations of the study
This study was performed with electronic health records data that were routinely recorded in general practices. This type of data has advantages and disadvantages. Advantages are that the data is cheap, readily available and can be assumed in many respects to represent what actually takes place in clinical practice. However, it also means that circumstances, habits and customs of individual practices in the way data are recorded, can have an impact on the quality of the data . In this study this may have contributed to the fact that we had to exclude 8.5% of all consultations. These consultations had to be excluded because these consultations did not appear to have taken place with the GP but with other practice personnel. The percentage of consultations with the GP is likely to be an underestimate. Some of the consultations may have been taken care of by the GP, but recorded by a practice assistant.
In this study, we would have liked to include age of the GP. It has been shown that the years of experience of the GP correlates with antibiotics prescription . Because, on average, male GPs are older than female GPs , age might have been a confounder in this study. Another limitation is that we could not include information on patients’ expectations and concerns, which might also influence prescribing behavior .
Although the existence of comorbidity was reported by the GP, in this study we regarded comorbidities as present or non-present and did not investigate the role of individual comorbidities. However, COPD and diabetes are examples of diseases which affect susceptibility to disease and therefore possibly influence the prescribing behavior of the GP to a greater extent than most other diseases. In future research it would be important to include these comorbidities separately.
The current study focused solely on sore throat. Therefore, generalizing our findings to other complaints or symptoms should be done with caution. Future research should assess for a broader spectrum of symptoms whether prescription rates are related to gender concordance. Also, sore throat symptoms can be considered relatively gender neutral. This would be different when for example urogenital symptoms were concerned. This could change the effect of gender concordance. Further research could focus on the effect of gender concordance on antibiotics.
Implications of this study
In recent years the medical community in western societies has experienced a growth in number of female physicians . The results of this study suggest that this feminization could lead to a reduction in the prescription of antibiotics. Female concordance enhances patient centred 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 GPs, to contain the prescription of antibiotics.