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.
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 language | English |
|---|---|
| Article number | e037884 |
| Number of pages | 10 |
| Journal | BMJ Open |
| Volume | 10 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 17 Sept 2020 |