Holistic analysis of the determinants of antibiotic prescription in primary care in France: a cross-sectional study with nationwide panel data.

Abstract

Objectives: Antimicrobial resistance (AMR) is a critical public health issue, with overuse of antibiotics being a key driver. This study aimed to examine the determinants of antibiotic prescription in primary care in France, using nationwide panel data from 2022.

Methods: Data were obtained from several open sources. Antibiotic consumption was measured by the number of prescriptions of all systemic antibiotics per 1000 inhabitants, and patient, physician, healthcare system and seasonal viral outbreak (influenza and COVID-19) were considered as potential related factors. We then performed a linear multivariate regression model.

Results: The main findings were that patients <15 years (β = 7.36, P < 0.001), females (β = 9.54, P = 0.01), those with chronic diseases (β = 16.29, P < 0.001), white-collar workers (β = 3.40, P < 0.001) and European Deprivation Index score (β = 4.19, P < 0.001) had higher antibiotic prescription rates. Older physicians (age > 50 years: β = 1.35, P < 0.001) and those practising in areas with higher healthcare accessibility (Local Potential Accessibility score: β = 40.93, P < 0.001) were also associated with higher prescription volumes. In contrast, female physicians were linked to lower prescription rates (β = -0.62, P = 0.002).

Conclusions: The study emphasizes the complexity of antibiotic prescription behaviours, showing that both clinical and non-clinical factors contribute to prescription patterns. It also highlights social and accessibility factors as significant drivers of antibiotic use. In order to be effective, strategies for the correct use of antibiotics must account for these different aspects.