Een kwantitatieve vergelijking van medisch handelen tussen huisartsen met en zonder tropenervaring

Objective: A comparison of clinical treatment given by GPs with and without medical experience in the developing countries. Method: All GPs (517) from one district centre in the Netherlands received a questionnaire regarding relevant working experience in tropical medicine, the latter defined as at least 2 years' medical practice in a Third World country preceded by a standard training of 2 years in surgery, obstetrics and tropical medicine. Four parameters of clinical management were used to compare the GPs with tropical experience and their colleagues: prescription, referral, external diagnostic procedures (laboratory investigations and radiology) and minor procedures (surgery, ECGs and lung function tests). Data for 1999 were obtained from the district health insurance database, covering 570,000 patients and standardised for 1000 patients per year. The results were corrected for relevant GP and practice characteristics (age of the GP, list size, level of urbanisation, social setting and type of residence). Results: Almost 8% of the research group had at least 2 years' experience in tropical medicine. Univariate analysis demonstrated that on average these GPs referred 95% fewer patients than their colleagues. The number of prescriptions (-7,5%) and external diagnostic procedures (-12%) was also lower but proved not to be significant. Former tropical doctors carried out more procedures in their surgery. However multivariate analysis failed to show that experience in the Third World had a significant influence on differences in clinical management, nor did other GP and practice characteristics. Effect modification occurred between age and practice setting, organisation and list size. The maximum explained variance in this multivariate model was 32%. Conclusion: Differences between GPs in clinical management are not explained by work experience in developing countries.