Variability of medical practice in sinusitis as a function of resource utilization

• Published in: Atención primaria Vol. 26; no. 4; pp. 203 - 209
• Main Authors: Molinos Castro, S, González Martínez, R, Cimas, J E, Cabal, A, Carril, E
• Format: Journal Article
• Language: Spanish
• Published: Spain 15.09.2000
• Subjects: Adult; Cross-Sectional Studies; Female; Health Care Costs; Health Expenditures; Health Resources - statistics & numerical data; Humans; Linear Models; Male; Primary Health Care; Sinusitis - economics; Sinusitis - therapy; Spain
• ISSN: 0212-6567; 1578-1275

To find what factors linked to the doctor affect the variability of clinical practice. Cross-sectional descriptive study through a clinical interview with a fictitious complaint (sinusitis). Asturias health centres. 132 doctors chosen through conglomerate sampling. MEASUREMENTS AND MAIN-RESULTS: Social and professional variables of the doctor (sex, age, years in practice, postgraduate training, courses, recycling courses and distance to the referral centre) were gathered. After the case was presented, the doctor's actions were noted and the cost in pesetas of each action was noted. Cost and the consumption of resources were related to the personal variables of the doctors through multivariate analysis. Mean total expenditure was 76,592 pesetas (minimum: 8958; maximum: 244,220), of which 55,550 were for short-term time off work (average of ten days off) and 15,261 for the consultations made. Average cost of treatment was 3762 pesetas. Through multiple linear regression, the only variable that showed significant effect on expenditure was distance to the referral centre (the greater the distance, the less expenditure). On transforming the total expenditure variable into a dichotomous variable (above and below the mean), the variables with significant effect on less expenditure were courses done, greater distance from the referral centre and being a woman. There is a very broad variability in decision-taking before the same clinical problem. The only variables that explain (and only partially) an expenditure trend are sex, distance to the referral centre and doing courses.