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

Abstract

Objective. 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. Design. Qualitative content analysis was used to analyse semi-structured interviews. Setting. Swedish primary care. Subjects. A strategic sample of 25 GPs. Main outcome measures. Perceived management of sore throat patients. Results. 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. Conclusion. 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.

Knowledge About Prescribing Antibiotics for Patients With Acute Pharyngitis and Its Associate Factors Among Primary Health Care Physicians at Ministry of Health Makkah Al-Mukarramah City, 2016.

“…Similar findings were reported by Hedin et al (2014), who found that one-third of primary care physicians did not remember the Centor criteria and were therefore not able to use them. They added that while individual signs are not sufficient for the diagnosis of acute pharyngitis caused by group A streptococci, the Centor score is considered a well-calibrated decision rule for assessing the probability of group A streptococci.…”

“…They added that while individual signs are not sufficient for the diagnosis of acute pharyngitis caused by group A streptococci, the Centor score is considered a well-calibrated decision rule for assessing the probability of group A streptococci. (17) In the Democratic Republic of Congo, Thriemer et al (2013) reported that sources of physicians' knowledge related to antibiotic prescribing included pharmaceutical companies (73.9%), antibiotic guidelines (66.3%), university courses (63.6%), internet-sites (45.7%) and WHO guidelines (26.6%). (18) This study showed that the highest participants' answer regarding the best antibiotic used in the treatment of acute bacterial pharyngitis was penicillin (90.7%), with oral administration as the best route for administration (92.1%) for 5-7 days (72.9%).…”

“…(26) Sanchez et al (2014) noted that modifying prescriber physicians' behavior is a complex and difficult endeavor, which includes several interventions, (e.g., continuing medical education through interactive group meetings, guidelines). (17) Tennant et al (2010) emphasized that continuing educational programs and institution-specific guidelines are needed to improve physicians' knowledge regarding antibiotics prescription. (18) Gonzalez et al (2015) supported the ability to modify prescriber physicians' knowledge and behavior , even it is a complex and difficult and includes several interventions, (e.g., continuing medical education through interactive group meetings, guidelines).…”

“…Regarding knowledge questions (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), a score of 1 was given to right answer which is the first choice for all questions except number 36 the right answer is the second choice. The total score was computed by summation of scores and it was 18, the range was (0-18).…”

Reduction in antibiotic prescribing for respiratory tract infections in Swedish primary care- a retrospective study of electronic patient records

“…Swedish interview studies have indicated that high prescribing doctors were not aware of or not updated on the national guidelines for tonsillitis [31], which may explain the current findings. Finally, excessive use of CRP as a diagnostic tool, was noted, particularly in association with common cold and sore throat, which is not according to guidelines.…”