Objectives: To analyse the prescription of insulin and oral diabetic medication (ODM) in primary health care, and to evaluate which variables, depending on the prescribing doctor, work-place or population attended, explain quality and/or quantity variations in prescription.
Design: Crossover, observational study.
Setting: Málaga-Este Health District, Málaga.
Participants: 21,166 prescriptions issued by 144 doctors in the Málaga-Este Health District during the first quarter of 1997 were analysed.
Measurements and main results: Insulin consumption of 10.63 defined daily doses per 1,000 inhabitants and day (DID) and ODM of 18.51 DID were calculated. No significant differences were observed in insulin or ODM prescription for sex, and few for age, job or doctors' specialty via MIR (intern) training. Working in a centre with MIR teaching and in a reformed centre were significantly associated with a greater use of insulin (p < 0.0001 and p < 0.02, respectively). Having a higher allocation of patients drawing pensions meant a greater consumption of insulin (p < 0.01) and even more of ODM (p < 0.0001). The population allocated being older was associated with greater consumption of ODM without any changes in insulin prescription.
Conclusions: The personal features of doctors working in primary care affect very little the quantity and quality of insulin and ODM prescription. The characteristics of the work-place (reformed centre and centre entitled to teach) and the population attended (older and drawing a pension) are the main factors conditioning the amount of prescription of insulin and ODM, respectively. Nevertheless, in all cases ODM prescription quality is low.