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Explaining medical practice variation: social organization and institutional mechanisms.

Jong, J. de, Groenewegen, P.P., Westert, G.P. Explaining medical practice variation: social organization and institutional mechanisms. European Journal of Public Health: 2009, 19(suppl. 1) 14. Abstract. 17th European Public Health Conference 'Human Ecology and Public Health', 25–28 November 2009, Lodz (Polen).
Background: In general, patients expect that the medical treatment they receive is provided by physicians who adhere to professional norms which are based on evidence. The existence of variations in medical practice challenges that general belief. In the assumption that treatment by physicians is based on theoretical knowledge and the medical condition of the patient, similar patients with similar conditions would receive the same treatment, irrespective of the physician, hospital or practice they attend. However, examples from literature show a different situation. In this study, we tested several hypotheses on the causes of medical practice variation. Methods: Data were used from two national data collections held in the Netherlands amongst general practitioners: the First and Second Dutch National Survey of General Practice. These data were collected in 1987 and 2001, respectively. Furthermore, data were obtained from the New York Statewide Planning and Research Cooperative System (SPARCS). The 1999, 2000 and 2001 SPARCS data were used. The analyses were performed using multilevel analyses. Results: The results point towards the importance of similarities based on shared circumstances. It also shows that the most common explanation of medical practice variations based on individual preferences is unsatisfactory. Conclusion: Medical practice variations are not merely individual differences in preferred practice styles, but are patterned by social processes in partnerships and local circumstances. We showed that institutional mechanisms are effective in influencing physicians’ behaviour, and therefore could be used in limiting variation. However, we found no empirical evidence proving that institutional mechanisms reduce variation in this study.
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