Aim: This study examined how systemic and regional factors influence family physicians’ prescribing of antibiotics, analgesics, and injectable drugs to support health equity and rational medicine use.Material and Methods: An ecological, cross-sectional design was employed using provincial-level data from the The Ministry of Health of Türkiye for the year 2023. Dependent variables were provincial proportions of family physician prescriptions for antibiotics, analgesics, and injectables. Fifteen independent system-level indicators were analyzed. Principal Component Analysis reduced these to four latent factors. Separate ordinal logistic regression models assessed associations between these factors and prescribing patterns. Regional differences were evaluated in models adjusted for these structural factors.Results: The factor for Primary Care Accessibility and Utilization was a consistent positive predictor for all drug categories (p0.001). In contrast, the factor for Chronic Disease Burden and Primary Response was negatively associated with antibiotic and analgesic prescribing (p0.001). Secondary/Tertiary Care Capacity was positively associated with antibiotic prescribing (p=0.004). Significant regional disparities persisted after adjustment for these structural factors. Compared to Southeastern Anatolia, the Black Sea and Marmara regions had significantly lower adjusted prescribing ranks for antibiotics and analgesics (p0.05).Conclusion: System-level factors like access to specific types of care, patient load, population density, and resource availability influence family physicians’ prescription behaviors. Moreover, these prescribing patterns also reflect persistent regional inequalities beyond these structural factors. Policies promoting rational medicine use must therefore adopt a dual strategy: addressing the structural imbalances in healthcare infrastructure while simultaneously intervening in the regional clinical cultures that drive prescribing behavior.
Ünlü et al. (Sun,) studied this question.