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Uncertainty in clinical practice - an interview study with Swedish GPs on patients with sore throat
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Department Public Health and Caring Science, Sweden.
Uppsala University, Sweden.
Lund University, Sweden; Blekinge County Council, Sweden.
Lund University, Sweden; Skåne Reg, Sweden.
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2016 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, no 56Article in journal (Refereed) PublishedText
Abstract [en]

Background: Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines. Methods: An interview study was conducted among a strategic sample of 25 general practitioners (GPs). Results: All GPs mentioned potential dangerous differential diagnoses and complications. Four strategies for coping with uncertainty were identified, one of which was compliant with guidelines, "Adherence to guidelines", and three were idiosyncratic: "Clinical picture and C-reactive protein (CRP)", "Expanded control", and "Unstructured". The residual uncertainty differed for the different strategies: in the strategy "Adherence to guidelines" and " Clinical picture and CRP" uncertainty was avoided, based either on adherence to guidelines or on the clinical picture and near-patient CRP; in the strategy " Expanded control" uncertainty was balanced based on expanded control; and in the strategy "Unstructured" uncertainty prevailed in spite of redundant examination and anamnesis. Conclusion: The majority of the GPs avoided uncertainty and deemed they had no problems. Their strategies either adhered to guidelines or comprised excessive use of tests. Thus use of guidelines as well as use of more near-patient tests seemed associated to reduced uncertainty, although the later strategy at the expense of compliance to guidelines. A few GPs did not manage to cope with uncertainty or had to put in excessive work to control uncertainty.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2016. Vol. 17, no 56
Keyword [en]
Uncertainty; General practitioners; Sore throat; Guideline; C-reactive protein; Qualitative research
National Category
Social and Clinical Pharmacy
URN: urn:nbn:se:liu:diva-129157DOI: 10.1186/s12875-016-0452-9ISI: 000375989200001PubMedID: 27188438OAI: diva2:936040

Funding Agencies|Kronoberg County Council; South Swedish Regional Council; University of Uppsala, Sweden

Available from: 2016-06-13 Created: 2016-06-13 Last updated: 2016-07-07

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