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Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat - a qualitative interview study.

Gröndal H, Hedin K, Strandberg EL, André M, Brorsson A - BMC Fam Pract (2015)

Bottom Line: The GPs expressed a belief that the clinical picture was sufficient for diagnosis in typical cases.Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge.When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.

View Article: PubMed Central - PubMed

Affiliation: Department of Sociology, Uppsala University, Uppsala, Sweden. hedvig.grondal@soc.uu.se.

ABSTRACT

Background: Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended with 2-4 Centor criteria present and antibiotics were recommended if the test was positive. C- reactive protein (CRP) was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies.

Methods: From a larger project 16 general practitioners (GPs) who stated management of sore throats not according to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the management of sore throats and the use of near-patient tests. Qualitative content analysis was used.

Results: The use of the near-patient test interplayed with the clinical assessment and the perception that all infections caused by bacteria should be treated with antibiotics. The GPs expressed a belief that the clinical picture was sufficient for diagnosis in typical cases. RADT was not believed to be relevant since it detects only one bacterium, while CRP was considered as a reliable numerical measure of bacterial infection.

Conclusions: Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge. When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.

No MeSH data available.


Related in: MedlinePlus

Different paths to antibiotic prescribing for sore throat in primary health care. The red arrow shows the diagnostic process according to guidelines. The black arrows show different deviations from guidelines reported by the participating GPs
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Fig1: Different paths to antibiotic prescribing for sore throat in primary health care. The red arrow shows the diagnostic process according to guidelines. The black arrows show different deviations from guidelines reported by the participating GPs

Mentions: The strategies reported by the GPs showed different alternatives deviating from guidelines for handling patients with sore throat. The clinical assessment and the laboratory tests seemed to interact in an intricate manner, which meant that there were several ways to end up in the notion of bacterial infection. These strategies are presented in a scheme where the different paths to bacterial infection – and thus antibiotics – become apparent (Fig. 1).Fig. 1


Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat - a qualitative interview study.

Gröndal H, Hedin K, Strandberg EL, André M, Brorsson A - BMC Fam Pract (2015)

Different paths to antibiotic prescribing for sore throat in primary health care. The red arrow shows the diagnostic process according to guidelines. The black arrows show different deviations from guidelines reported by the participating GPs
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4491276&req=5

Fig1: Different paths to antibiotic prescribing for sore throat in primary health care. The red arrow shows the diagnostic process according to guidelines. The black arrows show different deviations from guidelines reported by the participating GPs
Mentions: The strategies reported by the GPs showed different alternatives deviating from guidelines for handling patients with sore throat. The clinical assessment and the laboratory tests seemed to interact in an intricate manner, which meant that there were several ways to end up in the notion of bacterial infection. These strategies are presented in a scheme where the different paths to bacterial infection – and thus antibiotics – become apparent (Fig. 1).Fig. 1

Bottom Line: The GPs expressed a belief that the clinical picture was sufficient for diagnosis in typical cases.Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge.When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.

View Article: PubMed Central - PubMed

Affiliation: Department of Sociology, Uppsala University, Uppsala, Sweden. hedvig.grondal@soc.uu.se.

ABSTRACT

Background: Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended with 2-4 Centor criteria present and antibiotics were recommended if the test was positive. C- reactive protein (CRP) was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies.

Methods: From a larger project 16 general practitioners (GPs) who stated management of sore throats not according to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the management of sore throats and the use of near-patient tests. Qualitative content analysis was used.

Results: The use of the near-patient test interplayed with the clinical assessment and the perception that all infections caused by bacteria should be treated with antibiotics. The GPs expressed a belief that the clinical picture was sufficient for diagnosis in typical cases. RADT was not believed to be relevant since it detects only one bacterium, while CRP was considered as a reliable numerical measure of bacterial infection.

Conclusions: Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge. When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.

No MeSH data available.


Related in: MedlinePlus