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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
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
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2015 (English)In: BMC Family Practice, ISSN 1471-2296, Vol. 16, 81Article in journal (Refereed) Published
Abstract [en]

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 Conclusions: Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge.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.

Place, publisher, year, edition, pages
2015. Vol. 16, 81
Keyword [en]
Near-patient tests, Sore throat, Guidelines, Decision-making, Qualitative interview study
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
URN: urn:nbn:se:uu:diva-259091DOI: 10.1186/s12875-015-0285-yISI: 000357305200001PubMedID: 26141740OAI: diva2:843464
Available from: 2015-07-28 Created: 2015-07-27 Last updated: 2015-07-28Bibliographically approved

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Gröndal, HedvigAndré, Malin
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