Programme no. 426-OP
Near-patient tests and the clinical gaze in Swedish
GPs not following current guidelines for sore throat –
a qualitative interview study
Annika Brorsson*1, Katarina Hedin2, Hedvig Gröndal3, Eva Lena Strandberg4, Malin André5
1Department of Clinical Sciences, Malmö, Family Medicine,Lund University,Malmö,Sweden, 2Department of Clinical Sciences, Malmö, Family Medicine,Lund University,Malmö,Sweden, 3Department of Sociology,Uppsala University,Uppsala,Sweden, 4Department of Clinical Sciences, Malmö, Family Medicine,Lund University,Malmö,Sweden, 5Department of Public Health and Caring Sciences – Family Medicine and,Uppsala University,Uppsala,Sweden
* = Presenting author
Objectives: To deepen the understanding of GPs' use of near-patient test in patients with sore throat
Excessive antibiotics use increases the risk of resistance. Previous studies have shown
that the Centor score combined with RADT for GAS 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. CRP was not recommended for sore
throats. Inappropriate use of RADT and CRP has been reported in several studies.
The use of the near-patient test interplayed with the clinical gaze and the perception
that all infections caused by bacteria should be treated with antibiotics. The GPs
expressed a belief that the clinical gaze was sufficient for diagnosis in typical cases.
RADT was not trusted since it detects only one bacterium, while CRP was considered
as a reliable numerical measure of bacterial infection.
From a larger project 16 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 near41
patient tests. Qualitative content analysis was used.
Inappropriate use of near-patient test can partly be understood as remnants of outdated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.
Points for discussion: How could the implementation of new guidelines be improved?