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Are Physicians With Better Clinical Skills on Licensing Examinations Less Likely to Prescribe Antibiotics for Viral Respiratory Infections in Ambulatory Care Settings?

Cadieux, Genevieve MSc*; Abrahamowicz, Michal PhD*†; Dauphinee, Dale MD; Tamblyn, Robyn PhD*‡

doi: 10.1097/MLR.0b013e3182028c1a
Original Article

Background: Viral respiratory infections (VRIs) are a common reason for ambulatory visits, and 35% are treated with an antibiotic. Antibiotic use for VRIs is not recommended, and it promotes antibiotic resistance. Effective patient-physician communication is critical to address this problem. Recognizing the importance of physician communication skills, licensure examinations were reformed in the United States and Canada to evaluate these skills.

Objective: To assess whether physician clinical and communication skills, as measured by the Canadian clinical skills examination (CSE), predict antibiotic prescribing for VRI in ambulatory care.

Research Design and Subjects: A total of 442 Quebec general practitioners and pediatricians who wrote the CSE in 1993–1996 were followed from 1993 to 2007, and their 159,456 VRI visits were identified from physician claims.

Measures: The outcome was an antibiotic prescription from a study physician dispensed within 7 days of the VRI visit. Multivariate logistic regression analyses were used to estimate the association between antibiotic prescribing for VRI and CSE score, adjusting for physician, patient, and encounter characteristics.

Results: Better clinical and communication skills were associated with a reduction in the risk of antibiotic prescribing, but only for female physicians. Every 1-standard deviation increase in CSE score was associated with a 19% reduction in the risk of antibiotic prescribing (risk ratio, 0.81; 95% confidence interval, 0.68–0.97). Better clinical skills were associated with an even greater reduction in risk among female physicians with higher workloads (risk ratio, 0.48; 95% confidence interval, 0.29–0.79).

Conclusion: Physician clinical and communication skills are important determinants of antibiotic prescribing for VRI and should be targeted by future interventions.

From the *Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; †Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec, Canada; and ‡Department of Medicine, Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada.

Supported by the Medical Council of Canada (MCC) and the Canadian Institutes of Health Research (CIHR) for this study.

The CIHR had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The MCC and the College of Physicians of Quebec, as organizations, were not involved in the approval of this article.

Reprints: Genevieve Cadieux, MSc, McGill University, Clinical and Health Informatics Research Group, 1140 Pine Ave West, Montreal, Quebec H3A 1A3, Canada. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.