Short summary

A questionnaire study is conducted among general practitioners (GPs) in Denmark to investigate the management of infectious diseases, especially what affect the GP when choosing whether or not to prescribe antibiotics. We will also study elicit what motivates the GPs in their work and how they experience workload in their work. Data will be linked to prescribing data to explore if work motivation profiles influence prescribing patterns of the GP.

Rationale

The project is composed of two studies. The first study is aiming to explore the factors influence general practitioners when handling infections and deciding to prescribe antibiotics. The objective of the second study is to identify what motivates general practitioners in their work and how they experience workload. Furthermore, this study will investigate whether differences in motivational profiles among GPs are associated with different patterns in treatment of patients. 

Antibiotics are essential in the treatment of life-threatening infections. However, an increasing development of antibiotic resistance is threatening this. To a large extent, resistant bacteria are selected as a result of the use of broad-spectrum antibiotics. In Denmark, the antibiotic consumption has been increasing during recent years, in particularly seen in the use of broad-spectrum antibiotics in general practice. Concurrently, an increase is seen in the prevalence of bacteria resistant to current antibiotics. The development of new antibiotics does not progress at the same high pace as the development of resistance, which is why a rational use of antibiotics is essential to enable a continuous control of infections. 

The variation in general practitioners' (GPs) prescribing patterns has not been investigated in a Danish context, but international studies show a large variation. The underlying reasons for this have not been clarified. The first study will investigate the GPs' attitudes to antibiotic prescribing, including the factors influencing the GPs when deciding on antibiotic prescribing. Prior to this study, we have conducted a qualitative interview study to investigate factors of importance to GPs' prescribing patterns. A number of possible influencing factors, such as the use of point-of-care tests, GPs' own experiences, guidelines/information from courses as well as the patients' expectations, have been identified.

The second study investigates whether GPs' personal characteristics and motivation profiles are important explanatory factors for understanding variation in GPs' implementation of research-based knowledge and its socio-economic impact.  

Recent literature shows that intrinsically motivated health care professionals provide high-quality care even in the absence of external incentives.  For the less intrinsically motivated health care professionals other personal characteristics are likely to play a role for their care. As GPs act as agents for both their patients and the third-party payer, they face a double agency problem, aiming to satisfy two principals. The degree to which the GPs align with third-party goals and signals depends on their degree of public service motivation and user orientation. 

The GPs' motivational profiles will be elicited by means of a baseline and follow-up survey sent to all GPs in Denmark (in 2018 and 2020). The surveys will include the different components in the GPs' utility functions, i.e. patients' utility of treatment, reimbursement (extrinsic motivation), the consideration for society/the third-party payer (public service motivation), and the GPs' inner joy with their work (intrinsic motivation). The answers to the survey enable us to estimate the extent to which the individual GP is motivated by each component. In the survey, we also include questions on other personal characteristics and questions relating to GPs' perceived resource constraints, e.g. time pressure and whether they are actively looking for more personnel etc. 

Description of the cohort

All general practitioners in Denmark are invited to participate in the study.

Data and biological material

- From public registers: Name, provider number, sex, geography, type of practice

- From questionnaire survey: work satisfaction, motivation, workload, management of infections, attitude to treatment of patients, society, and health authorities

- From registers: Information about medical prescriptions and/or services

Collaborating researchers and departments

Research Unit of General Practice, University of Southern Denmark

• PhD student Rikke Vognbjerg Sydenham, MD
• Professor Dorte Ejg Jarbøl, MD, PhD

Danish Centre for Health Economics & Research Unit for General Practice

• Cand.oecon Associate professor Line Bjørnskov Pedersen, PhD

Danish Centre for Health Economics

• Cand.oecon, Professor, Research Leader Dorte Gyrd-Hansen, PhD
• Cand.oecon, Postdoc Anne Sophie Oxholm, PhD

Department of Clinical Microbiology

• Associate professor, DMSc Ulrik Stenz Justesen, MD