Association between guidelines and medical practitioners’ perception of best management for patients attending with an apparently uncomplicated acute sore throat: a cross-sectional survey in five countries
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.Sett...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-09-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e037884.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841555781434998784 |
|---|---|
| author | Alastair D Hay Mark H Ebell Ronny Gunnarsson Pär-Daniel Sundvall Katarina Hedin Hannelore Wächtler Naveen Manchal Lynne Reid Stefan Malmberg Sean Hawkey |
| author_facet | Alastair D Hay Mark H Ebell Ronny Gunnarsson Pär-Daniel Sundvall Katarina Hedin Hannelore Wächtler Naveen Manchal Lynne Reid Stefan Malmberg Sean Hawkey |
| author_sort | Alastair D Hay |
| collection | DOAJ |
| description | 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 healthcare (PHC).Participants Medical practitioners working in PHC.Main outcome measures ORs for: (A) perception of throat swabs as important, (B) perception of blood tests (C reactive protein, B-ESR and B-leucocytes) as important and (C) antibiotic prescriptions if no pathogenic bacteria isolated on throat swab.Results Guidelines differed significantly; those recommending throat swabs (Sweden and USA) were associated with practitioners perceiving them as important. The UK guideline was the only one actively discouraging the use of throat swabs. Hence, compared with the USA (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 to 6.1) for adults, whereas it reduced the probability in Sweden for adults OR 0.35 (95% CI 0.13 to 0.96) and children 0.19 (95% CI 0.069 to 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. |
| format | Article |
| id | doaj-art-cdd3ba42af044e0693ff52db509a531b |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-cdd3ba42af044e0693ff52db509a531b2025-01-08T03:15:09ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2020-037884Association between guidelines and medical practitioners’ perception of best management for patients attending with an apparently uncomplicated acute sore throat: a cross-sectional survey in five countriesAlastair D Hay0Mark H Ebell1Ronny Gunnarsson2Pär-Daniel Sundvall3Katarina Hedin4Hannelore Wächtler5Naveen Manchal6Lynne Reid7Stefan Malmberg8Sean Hawkey94 NIHR Health Protection Research Unit in Evaluation of Interventions, Centre for Academic Primary Care, University of Bristol School of Social and Community Medicine, Bristol, UKDepartment of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USAResearch, Development, Education and Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Swedengeneral practitioner and associate professorFaculty of Medicine and Health Sciences, Linköping University, Linköping, SwedenFaculty of Medicine, Institute for General Practice, Christian-Albrechts-Universität zu Kiel, Kiel, GermanyCairns Clinical School, James Cook University College of Medicine and Dentistry, Cairns, Queensland, AustraliaCairns Clinical School, James Cook University College of Medicine and Dentistry, Cairns, Queensland, AustraliaGeneral Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenCentre for Academic Primary Care, NIHR School for Primary Care Research, Population Health Sciences, University of Bristol Medical School, Bristol, UKObjective 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 healthcare (PHC).Participants Medical practitioners working in PHC.Main outcome measures ORs for: (A) perception of throat swabs as important, (B) perception of blood tests (C reactive protein, B-ESR and B-leucocytes) as important and (C) antibiotic prescriptions if no pathogenic bacteria isolated on throat swab.Results Guidelines differed significantly; those recommending throat swabs (Sweden and USA) were associated with practitioners perceiving them as important. The UK guideline was the only one actively discouraging the use of throat swabs. Hence, compared with the USA (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 to 6.1) for adults, whereas it reduced the probability in Sweden for adults OR 0.35 (95% CI 0.13 to 0.96) and children 0.19 (95% CI 0.069 to 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.https://bmjopen.bmj.com/content/10/9/e037884.full |
| spellingShingle | Alastair D Hay Mark H Ebell Ronny Gunnarsson Pär-Daniel Sundvall Katarina Hedin Hannelore Wächtler Naveen Manchal Lynne Reid Stefan Malmberg Sean Hawkey Association between guidelines and medical practitioners’ perception of best management for patients attending with an apparently uncomplicated acute sore throat: a cross-sectional survey in five countries BMJ Open |
| title | Association between guidelines and medical practitioners’ perception of best management for patients attending with an apparently uncomplicated acute sore throat: a cross-sectional survey in five countries |
| title_full | Association between guidelines and medical practitioners’ perception of best management for patients attending with an apparently uncomplicated acute sore throat: a cross-sectional survey in five countries |
| title_fullStr | Association between guidelines and medical practitioners’ perception of best management for patients attending with an apparently uncomplicated acute sore throat: a cross-sectional survey in five countries |
| title_full_unstemmed | Association between guidelines and medical practitioners’ perception of best management for patients attending with an apparently uncomplicated acute sore throat: a cross-sectional survey in five countries |
| title_short | Association between guidelines and medical practitioners’ perception of best management for patients attending with an apparently uncomplicated acute sore throat: a cross-sectional survey in five countries |
| title_sort | association between guidelines and medical practitioners perception of best management for patients attending with an apparently uncomplicated acute sore throat a cross sectional survey in five countries |
| url | https://bmjopen.bmj.com/content/10/9/e037884.full |
| work_keys_str_mv | AT alastairdhay associationbetweenguidelinesandmedicalpractitionersperceptionofbestmanagementforpatientsattendingwithanapparentlyuncomplicatedacutesorethroatacrosssectionalsurveyinfivecountries AT markhebell associationbetweenguidelinesandmedicalpractitionersperceptionofbestmanagementforpatientsattendingwithanapparentlyuncomplicatedacutesorethroatacrosssectionalsurveyinfivecountries AT ronnygunnarsson associationbetweenguidelinesandmedicalpractitionersperceptionofbestmanagementforpatientsattendingwithanapparentlyuncomplicatedacutesorethroatacrosssectionalsurveyinfivecountries AT pardanielsundvall associationbetweenguidelinesandmedicalpractitionersperceptionofbestmanagementforpatientsattendingwithanapparentlyuncomplicatedacutesorethroatacrosssectionalsurveyinfivecountries AT katarinahedin associationbetweenguidelinesandmedicalpractitionersperceptionofbestmanagementforpatientsattendingwithanapparentlyuncomplicatedacutesorethroatacrosssectionalsurveyinfivecountries AT hannelorewachtler associationbetweenguidelinesandmedicalpractitionersperceptionofbestmanagementforpatientsattendingwithanapparentlyuncomplicatedacutesorethroatacrosssectionalsurveyinfivecountries AT naveenmanchal associationbetweenguidelinesandmedicalpractitionersperceptionofbestmanagementforpatientsattendingwithanapparentlyuncomplicatedacutesorethroatacrosssectionalsurveyinfivecountries AT lynnereid associationbetweenguidelinesandmedicalpractitionersperceptionofbestmanagementforpatientsattendingwithanapparentlyuncomplicatedacutesorethroatacrosssectionalsurveyinfivecountries AT stefanmalmberg associationbetweenguidelinesandmedicalpractitionersperceptionofbestmanagementforpatientsattendingwithanapparentlyuncomplicatedacutesorethroatacrosssectionalsurveyinfivecountries AT seanhawkey associationbetweenguidelinesandmedicalpractitionersperceptionofbestmanagementforpatientsattendingwithanapparentlyuncomplicatedacutesorethroatacrosssectionalsurveyinfivecountries |