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OBJECTIVE: To study the variability and suitability of antibiotic prescription in primary care in the Basque Country. DESIGN: Prospective, descriptive study. SETTING: Basque Country health care centres both within and not in the reformed network. MEASUREMENTS AND MAIN RESULTS: 3182 infections from consultations for infectious disease were studied through sampling stratified by health area during February, March and April 1998. The appropriateness of antibiotics (ATB) prescription was compared with some standards after an extensive bibliographic review. 68.6% of consultations were infections not needing ATB (infections of respiratory airways, acute bronchitis, flu and gastro-enteritis). ATB were used in 28.5% of these cases (CI: 26.6-30.5), especially in acute bronchitis (90.7%) (CI: 87.3-93.4). Unnecessary prescription supposes 39.7% of total antibiotic prescription (CI: 37.2-42.1%), which means unnecessary annual expenditure of 1155 million pesetas. In 31.4% of the infections that require ATB treatment, in 23.7% inappropriate treatment was chosen (CI: 21-26.7%). Overall appropriateness of treatment was 72.2% (CI: 70.6-73.8). Working in the reformed system was linked to better prescription in all cases. Paediatricians prescribed better in the case of infections not susceptible to ATB treatment. CONCLUSIONS: ATB prescription is not consistent with the available scientific evidence. Incorrect treatments occur especially in benign and self-limiting processes. A local policy of ATB use that includes multi-disciplinary collaboration and effective ongoing training is necessary.

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Objetivo. Estudiar la variabilidad e idoneidad de la prescripción antibiótica en atención primaria en la Comunidad Autónoma Vasca (CAV).Diseño. Estudio descriptivo, prospectivo. Emplazamiento. Centros de atención primaria de la red reformada y no reformada de la CAV. Mediciones y resultados principales. Se estudiaron 3.182 infecciones obtenidas de consultas sobre enfermedad infecciosa mediante muestreo estratificado por área sanitaria durante febrero, marzo y abril de 1998. La idoneidad de la prescripción de antibióticos (ATB) se comparó con unos patrones elaborados tras una extensa revisión bibliográfica. Un 68,6 por ciento de las consultas son infecciones que no requieren ATB (catarro de vías altas [IRA], bronquitis aguda, gripe y gastroenteritis). Se utilizan ATB en un 28,5 por ciento de estos casos (IC, 26,6-30,5). Destaca la bronquitis aguda, con un 90,7 por ciento (IC, 87,3-93,4). La prescripción innecesaria supone un 39,7 por ciento de la prescripción total antibiótica (IC, 37,2-42,1 por ciento), suponiendo un gasto anual innecesario de 1.155 millones de pesetas. En el 31,4 por ciento de las infecciones que requieren tratamiento con ATB, se opta por uno no adecuado en un 23,7 por ciento (IC, 21-26,7 por ciento). En total, la idoneidad del tratamiento global fue del 72,2 por ciento (IC, 70,6-73,8). El hecho de trabajar en la red reformada se asoció a una mejor prescripción en todos los casos. Los pediatras prescriben mejor en el caso de las infecciones no susceptibles de tratamiento con ATB. Conclusiones. La prescripción de ATB no se realiza conforme a la evidencia científica disponible. Los tratamientos incorrectos tienen lugar sobre todo en procesos benignos y autolimitados. Es necesaria una política local de uso de ATB que incluya colaboración multidisciplinaria y formación continuada efectiva (AU)

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OBJECTIVES: To analyse the influence of independent factors, relating to the characteristics of primary care doctors, patients and the illness, on therapeutic attitudes and their variability before anxiety disorders. DESIGN: Observational study of people attending primary care family medicine clinics who are identified as suffering anxiety disorders. SETTING: The autonomous Communities of Castilla and Leon, the Basque Country and the Valencian Community. PARTICIPANTS: 3247 patients over 18 classified by their doctors as suffering an anxiety disorder. MEASUREMENTS AND RESULTS: During 1995, 317 primary care doctors collected information from patients with anxiety disorders (CIE codes F40 and F41). The information was gathered with the same questionnaire in the three communities. The data were validated monthly before the final analysis. Women doctors gave less medical advice than male doctors (OR: 0.48, 95% CI: 0.36-0.65). Patients with anxiety in Castilla and Leon were at greater "risk" of receiving drugs treatment than those in the Basque Country (OR: 1.64, CI: 1.31-2.06). When the consultation was for any mental symptom or when the kind of anxiety was a panic disorder (OR: 2.39, CI: 1.53-3.65), phobic disorder (OR: 2.17, CI: 1.52-3.08) or mixed anxiety disorder (OR: 2.20, CI: 1.77-2.73), patients were more likely to be referred for specialist treatment. If it was decided to prescribe drugs treatment, women doctors used more often than their male colleagues a mixed treatment with anti-depressants, anxiolytic drugs and drugs for psychosis (OR: 1.60, CI: 160-4.28). Castilla and Leon, and the Valencian Community were less likely to use mixed treatment than the Basque Country reference group. CONCLUSIONS: This study shows the variability in the difficulties encountered in diagnosis and finding a common standard of conduct for primary care doctors faced with patients suffering anxiety disorders. Although the treatment used for anxiety can be considered adequate in most cases, there is high variability, which depends mainly on the type and other characteristics of the process, the patient and the professional.

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