Association between guidelines and medical practitioners’ perception of best management for patients attending with an apparently uncomplicated acute sore throat: a cross-sectional survey in five countries

Ronny Gunnarsson*, Mark Ebell, Hannelore Wächtler, Naveen Manchal, Lynne Reid, Stefan Malmberg, Sean Hawkey, Alastair D Hay, Katarina Hedin, Pär-Daniel Sundvall

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

Abstract

OBJECTIVE To investigate the relationship between guidelines and the medical practitioners’ perception of optimal care for patients attending with an apparently uncomplicated acute sore throat in five countries (Australia, Germany, Sweden, UK and USA).

DESIGN International cross-sectional survey

SETTING Primary health care (PHC)

PARTICIPANTS Medical practitioners working in PHC

MAIN OUTCOME MEASURES Odds ratios (OR) for (a) perception of throat swabs as important, (b) perception of blood tests (CRP, B-ESR, B-Leukocytes) as important, and (c) antibiotic prescriptions if no pathogenic bacteria isolated on throat swab.

RESULTS Guidelines differed significantly; those recommending throat swabs (Sweden and US) were associated with practitioners perceiving them as important. The UK guideline was the only one actively discouraging the use of throat swabs. Hence, compared to the US (reference) a throat swab showing no pathogenic bacteria increased the probability of antibiotic prescribing in the UK with OR 3.2 (95% CI 1.7-6.1) for adults whereas it reduced the probability in Sweden for adults OR 0.35 (95% CI 0.13-0.96) and children 0.19 (95% CI 0.069-0.50).

CONCLUSIONS The differences between practitioners’ perceptions of best management were associated with their guidelines. It remains unclear if guidelines influenced medical practitioners’ perception or if guidelines merely reflect the consensus of current practice. A larger effort should be made to reach an international consensus in high-income countries about the best management of patients attending for an uncomplicated acute sore throat.
Original languageEnglish
Article numbere037884
Number of pages10
JournalBMJ Open
Volume10
Issue number9
DOIs
Publication statusPublished - 17 Sep 2020

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