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Management of patients with sore throats in relation to guidelines: an interview study in Sweden.

https://arctichealth.org/en/permalink/ahliterature263170
Source
Scand J Prim Health Care. 2014 Dec;32(4):193-9
Publication Type
Article
Date
Dec-2014
Author
Katarina Hedin
Eva Lena Strandberg
Hedvig Gröndal
Annika Brorsson
Hans Thulesius
Malin André
Source
Scand J Prim Health Care. 2014 Dec;32(4):193-9
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Adult
Anti-Bacterial Agents - therapeutic use
Disease Management
Drug Prescriptions
Family Practice - methods
Female
Guideline Adherence - standards
Humans
Male
Middle Aged
Pharyngitis - drug therapy
Physician's Practice Patterns - statistics & numerical data
Qualitative Research
Sweden - epidemiology
Abstract
To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews.
Qualitative content analysis was used to analyse semi-structured interviews.
Swedish primary care.
A strategic sample of 25 GPs.
Perceived management of sore throat patients.
It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identified and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs.
This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.
Notes
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PubMed ID
25363143 View in PubMed
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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.

https://arctichealth.org/en/permalink/ahliterature271142
Source
BMC Fam Pract. 2015;16:81
Publication Type
Article
Date
2015
Author
Hedvig Gröndal
Katarina Hedin
Eva Lena Strandberg
Malin André
Annika Brorsson
Source
BMC Fam Pract. 2015;16:81
Date
2015
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Attitude of Health Personnel
Disease Management
Female
General Practitioners - psychology - standards - statistics & numerical data
Guideline Adherence - statistics & numerical data
Humans
Immunologic Tests - methods - statistics & numerical data
Inappropriate Prescribing - prevention & control
Male
Middle Aged
Pharyngitis - diagnosis - drug therapy - etiology - microbiology
Point-of-Care Testing - statistics & numerical data
Practice Guidelines as Topic
Practice Patterns, Physicians'
Qualitative Research
Streptococcus pyogenes - immunology - isolation & purification
Sweden
Symptom Assessment
Abstract
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.
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.
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.
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.
Notes
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Cites: Scand J Prim Health Care. 2014 Dec;32(4):193-925363143
PubMed ID
26141740 View in PubMed
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Setting priorities in primary health care--on whose conditions? A questionnaire study.

https://arctichealth.org/en/permalink/ahliterature118673
Source
BMC Fam Pract. 2012;13:114
Publication Type
Article
Date
2012
Author
Eva Arvidsson
Malin André
Lars Borgquist
David Andersson
Per Carlsson
Author Affiliation
Department of Medical and Health Sciences, National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden. eva.arvidsson@ltkalmar.se
Source
BMC Fam Pract. 2012;13:114
Date
2012
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Ambulatory Care
Attitude of Health Personnel
Attitude to Health
Chronic Disease
Cost-Benefit Analysis
Disease Management
Female
Health Priorities
Humans
Male
Middle Aged
Preventive Health Services
Primary Health Care
Questionnaires
Regression Analysis
Severity of Illness Index
Sweden
Abstract
In Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness. They are derived from the ethical principles established by the Swedish parliament 1997 but have been used only to a limited extent in primary care. The aim of this study was to describe and analyse: 1) GPs', nurses', and patients' prioritising in routine primary care 2) The association between the three key priority setting criteria and the overall priority assigned by the GPs and nurses to individual patients.
Paired questionnaires were distributed to all patients and the GPs or nurses they had contact with during a 2-week period at four health centres in Sweden. The staff registered the health conditions or health problem, and the planned intervention. Then they estimated the severity of the health condition, the expected patient benefit, and the cost-effectiveness of the planned intervention. Both the staff and the patients reported their overall prioritisation of the patient. In total, 1851 paired questionnaires were collected.
Compared to the medical staff, the patients assigned relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions. Severity of the health condition was the priority setting criterion that had the strongest association with the overall priority for the staff as a whole, but for the GPs it was cost-effectiveness.
The challenge for primary care providers is to balance the patients' demands with medical needs and cost-effectiveness. Transparent priority setting in primary care might contribute to a greater consensus between GPs and nurses on how to use the key priority setting criteria.
Notes
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PubMed ID
23181453 View in PubMed
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