Abstract
BackgroundThe national guideline for sore throat, endorsed by the Danish Society of General Medicine, recommends the use of the modified Centor score and streptococcal rapid antigen detection test to guide diagnosis and treatment of sore throat. The aim was to investigate Danish general practitioners (GPs) routine management of sore throat patients with a focus on the modalities used and adherence to the guideline.MethodsA cross-sectional study. GPs in the Central Denmark Region answered an online questionnaire in October 2017. The main outcome measure was modalities used in the management of sore throat patients.ResultsIn total, 266 of 500 (53%) GPs answered the survey. Ten percent of participants were adherent or almost adherent to the guideline, while 82% of GPs added one or more extra modalities (general clinical assessment (67%), biochemical parameters (48%), and throat swabs for bacterial culture (18%)) to differentiate viral and bacterial etiology. Sixty-five percent of participants used the Centor Score or modified Centor Score, 96% of GPs used a streptococcal rapid antigen detection test, and all GPs chose narrow-spectrum penicillin as the first-line antibiotic. The most common reasons for non-adherence to the guideline were greater confidence in the clinical assessment (39%), time pressure (33%), and difficulty recalling the guideline (19%).ConclusionDanish GPs rarely adhere to the recommended sore throat management guideline, but use various combinations of different modalities in the assessment of bacterial infection. This practice may increase antibiotic prescription rates.
Highlights
The national guideline for sore throat, endorsed by the Danish Society of General Medicine, recommends the use of the modified Centor score and streptococcal rapid antigen detection test to guide diagnosis and treatment of sore throat
The current Danish Society of General Medicine guideline for sore throat focuses on the detection of Group A streptococci (GAS) and limiting unnecessary antimicrobial therapy (Table 1)
The guideline is based on the modified Centor Score (McIsaac Score) to estimate the probability of GAS infection and, guide general practitioners (GPs) in the use of the streptococcal rapid antigen detection test (RADT) and the prescription of antibiotics [4]
Summary
The national guideline for sore throat, endorsed by the Danish Society of General Medicine, recommends the use of the modified Centor score and streptococcal rapid antigen detection test to guide diagnosis and treatment of sore throat. While previous quantitative studies on adherence to sore throat guidelines focus on the modalities used to select patients for antibiotic treatment and / or the choices of antibiotics, the current study was designed to gain insight into how GPs deviate from the guideline and the reasons for deviation from the recommended guideline [4, 6, 11,12,13]. This latter information is important in devising strategies to increase guideline adherence and reduce antibiotic prescription rates. The current study aimed to investigate the routine management of sore throat by Danish GPs with a focus on exploring the modalities used and identifying reasons for not adhering to the recommended guideline
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