Variations in chemoprophylaxis for meningococcal disease: a retrospective case note review, analysis of routine prescribing data and questionnaire of general practitioners

BACKGROUND: Invasive meningococcal disease is a significant cause of mortality and morbidity in the UK. Administration of chemoprophylaxis to close contacts reduces the risk of a secondary case. However, unnecessary chemoprophylaxis may be associated with adverse reactions, increased antibiotic resistance and removal of organisms, such as Neisseria lactamica, which help to protect against meningococcal disease. Limited evidence exists to suggest that overuse of chemoprophylaxis may occur. This study aimed to evaluate prescribing of chemoprophylaxis for contacts of meningococcal disease by general practitioners and hospital staff. METHODS: Retrospective case note review of cases of meningococcal disease was conducted in one health district from 1st September 1997 to 31st August 1999. Routine hospital and general practitioner prescribing data was searched for chemoprophylactic prescriptions of rifampicin and ciprofloxacin. A questionnaire of general practitioners was undertaken to obtain more detailed information. RESULTS: Prescribing by hospital doctors was in line with recommendations by the Consultant for Communicable Disease Control. General practitioners prescribed 118% more chemoprophylaxis than was recommended. Size of practice and training status did not affect the level of additional prescribing, but there were significant differences by geographical area. The highest levels of prescribing occurred in areas with high disease rates and associated publicity. However, some true close contacts did not appear to receive prophylaxis. CONCLUSIONS: Receipt of chemoprophylaxis is affected by a series of patient, doctor and community interactions. High publicity appears to increase demand for prophylaxis. Some true contacts do not receive appropriate chemoprophylaxis and are left at an unnecessarily increased risk

Optimal choice of electoral preference data

Electoral researchers are so much accustomed to analyzing the choice of the single most preferred party as the left-hand side variable of their models of electoral behavior that they often ignore revealed preference data. Drawing on random utility theory, their models predict electoral behavior at the extensive margin of choice. Since the seminal work of Luce and others on individual choice behavior, however, many social science disciplines (consumer research, labor market research, travel demand, etc.) have extended their inventory of observed preference data with, for instance, multiple paired comparisons, complete or incomplete rankings, and multiple ratings. Eliciting (voter) preferences using these procedures and applying appropriate choice models is known to considerably increase the efficiency of estimates of causal factors in models of (electoral) behavior. In this paper, we demonstrate the efficiency gain when adding additional preference information to first preferences, up to full ranking data. We do so for multi-party systems of different sizes. We use simulation studies as well as empirical data from the 1972 German election study. Comparing the practical considerations for using ranking and single preference data results in suggestions for choice of measurement instruments in different multi-candidate and multi-party settings.