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Li E, Dewez JE, Luu Q, Emonts M, Maconochie I, Nijman R, Yeung S. Role of point-of-care tests in the management of febrile children: a qualitative study of hospital-based doctors and nurses in England. BMJ Open 2021; 11:e044510. [PMID: 33972339 PMCID: PMC8112413 DOI: 10.1136/bmjopen-2020-044510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers' views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England. STUDY DESIGN Qualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically. SETTING Two university teaching hospitals in London and Newcastle. PARTICIPANTS 24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses). RESULTS There were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1-2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely. CONCLUSION In this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.
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Affiliation(s)
- Edmond Li
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College, London, UK
| | - Juan Emmanuel Dewez
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Queena Luu
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Marieke Emonts
- Department of Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Ian Maconochie
- Paediatric Emergency Department, St Mary's Hospital Imperial College Healthcare NHS Trust, London, UK
| | - Ruud Nijman
- Section of Paediatric Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Shunmay Yeung
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
- Department of Paediatric Infectious Disease, St Mary's Hospital Imperial College Healthcare NHS Trust, London, UK
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2
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Rusic D, Bukić J, Seselja Perisin A, Leskur D, Modun D, Petric A, Vilovic M, Bozic J. Are We Making the Most of Community Pharmacies? Implementation of Antimicrobial Stewardship Measures in Community Pharmacies: A Narrative Review. Antibiotics (Basel) 2021; 10:antibiotics10010063. [PMID: 33440609 PMCID: PMC7827930 DOI: 10.3390/antibiotics10010063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/01/2022] Open
Abstract
Community pharmacists recognize the need to implement antimicrobial stewardship activities in community pharmacies. They are in a unique position to provide triage for common primary care indications and to lower the burden of patients at general practitioners’ offices. However, research shows that, in some areas, dispensing of antimicrobials without valid prescription is still highly prevalent. Regardless of training, every community pharmacist can give his contribution to antimicrobial stewardship. One of the basic elements should be antimicrobial dispensing according to regulations, either prescription only, or according to guidelines where pharmacists have prescribing authority. Patient consultation supported with educational materials, such as leaflets, may reduce patients’ expectations to receive antibiotics for self-limiting infections and reduce pressure on general practitioners to prescribe antibiotics on patients’ demand. Treatment optimization may be achieved in collaboration with the prescribing general practitioners or by providing feedback. At last, pharmacists provided with additional training may be encouraged to provide consultation services to long-term care facilities, to introduce point-of-care testing for infectious diseases in their pharmacies or prescribe antimicrobials for uncomplicated infections. These services are welcomed by patients and communities. Expanding pharmacy services and pharmacists’ prescribing autonomy have shown a positive impact by reducing antibiotics consumption, thus ensuring better compliance with treatment guidelines.
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Affiliation(s)
- Doris Rusic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Josipa Bukić
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Ana Seselja Perisin
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Ana Petric
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
- The Split-Dalmatia County Pharmacy, Dugopoljska 3, 21 204 Dugopolje, Croatia
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia;
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia;
- Correspondence:
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3
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Aslaner H, Aslaner HA, Ertürk Arik B, Onuk FA, Benli AR, Mistik S. Rapid Antigen Detection Test Using Rates of Family Physicians, Test Results and Its Impact on Their Prescription Behaviours. EURASIAN JOURNAL OF FAMILY MEDICINE 2020. [DOI: 10.33880/ejfm.2020090405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The aim of this study is to determine the rates of rapid antigen detection test use, test results and its relationship with Modified Centor Score and investigate the effect of rapid antigen detection test use on prescribing behaviour.
Methods: This research was conducted by scanning the family physicians’ information system retrospectively. From the Family Medicine Information System, where polyclinics and prescription records of the family health centers where 12 family physicians work in Kayseri are located, the number and results of rapid antigen detection tests performed between February 2017 and April 2019, the Modified Centor Score automatically calculated by the system, the number of prescribed antibiotics and symptomatic treatment information was recorded.
Results: The positivity of rapid antigen detection test was considered, cut-off value of Modified Centor Score was >2 (ROC EAA:63.9, Cl:0.95,0.61-0.66). Sensitivity rate of the test for diagnostic score was 86% and selectivity rate was 48.8%.
Conclusion: Family physicians should be encouraged to use rapid antigen detection test. The fact that antibiotics are prescribed in rapid antigen detection testnegative patients may indicate that confidence level of the test is less than physical examination and clinical findings.
Keywords: sore throat, primary care, score
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Affiliation(s)
| | | | | | | | | | - Selcuk Mistik
- Department of Family Practice, Faculty of Medicine, Erciyes University
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4
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Gunnarsson R, Ebell MH, Wächtler H, Manchal N, Reid L, Malmberg S, Hawkey S, Hay AD, Hedin K, Sundvall PD. 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 2020; 10:e037884. [PMID: 32948565 PMCID: PMC7500311 DOI: 10.1136/bmjopen-2020-037884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Ronny Gunnarsson
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine at University of Gothenburg, Gothenburg, Sweden
- Research, Development, Education and Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Mark H Ebell
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Hannelore Wächtler
- Faculty of Medicine, Institute for General Practice, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Naveen Manchal
- Cairns Clinical School, James Cook University College of Medicine and Dentistry, Cairns, Queensland, Australia
| | - Lynne Reid
- Cairns Clinical School, James Cook University College of Medicine and Dentistry, Cairns, Queensland, Australia
| | - Stefan Malmberg
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine at University of Gothenburg, Gothenburg, Sweden
| | - Sean Hawkey
- Centre for Academic Primary Care, NIHR School for Primary Care Research, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Katarina Hedin
- Linköpings universitet Institutionen för medicin och hälsa, Linkoping, Sweden
- Futurum Academy of Health and Care, Jonkoping, Sweden
| | - Pär-Daniel Sundvall
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine at University of Gothenburg, Gothenburg, Sweden
- Research, Development, Education and Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
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5
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Burrowes SAB, Rader A, Ni P, Drainoni ML, Barlam TF. Low Uptake of Rapid Diagnostic Tests for Respiratory Tract Infections in an Urban Safety Net Hospital. Open Forum Infect Dis 2020; 7:ofaa057. [PMID: 32166096 PMCID: PMC7060900 DOI: 10.1093/ofid/ofaa057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/13/2020] [Indexed: 01/21/2023] Open
Abstract
Background Rapid diagnostic tests (RDTs) have been developed with the aim of providing accurate results in a timely manner. Despite this, studies report that provider uptake remains low. Methods We conducted a retrospective analysis of ambulatory, urgent care, and emergency department (ED) encounters at an urban safety net hospital with a primary diagnosis of an upper or lower respiratory tract infection (eg, bronchitis, pharyngitis, acute sinusitis) from January 1, 2016, to December 31, 2018. We collected RDT type and results, antibiotics prescribed, demographic and clinical patient information, and provider demographics. Results RDT use was low; a test was performed at 29.5% of the 33 494 visits. The RDT most often ordered was the rapid Group A Streptococcus (GAS) test (n = 7352), predominantly for visits with a discharge diagnosis of pharyngitis (n = 5818). Though antibiotic prescription was more likely if the test was positive (relative risk [RR], 1.68; 95% confidence interval [CI], 1.58–1.8), 92.46% of streptococcal pharyngitis cases with a negative test were prescribed an antibiotic. The Comprehensive Respiratory Panel (CRP) was ordered in 2498 visits; influenza was the most commonly detected pathogen. Physicians in the ED were most likely to order a CRP. Antibiotic prescription was lower if the CRP was not ordered compared with a negative CRP result (RR, 0.77; 95% CI, 0.7–0.84). There was no difference in prescribing by CRP result (negative vs positive). Conclusions RDTs are used infrequently in the outpatient setting, and impact on prescribing was inconsistent. Further work is needed to determine barriers to RDT use and to address potential solutions.
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Affiliation(s)
- Shana A B Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alec Rader
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Pengsheng Ni
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Evans Center for Implementation and Improvement Sciences (CIIS), Boston University School of Medicine, Boston, Massachusetts, USA.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford, Massachusetts, USA
| | - Tamar F Barlam
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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6
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Reinholdt KB, Rusan M, Hansen PR, Klug TE. Management of sore throat in Danish general practices. BMC FAMILY PRACTICE 2019; 20:75. [PMID: 31153357 PMCID: PMC6545212 DOI: 10.1186/s12875-019-0970-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 05/27/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND 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 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. METHODS A 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. RESULTS In 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%). CONCLUSION Danish 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.
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Affiliation(s)
- Kasper Basse Reinholdt
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
| | - Maria Rusan
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Otorhinolaryngology, Region Hospital Holstebro, Holstebro, Denmark
| | | | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
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7
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Demoré B, Tebano G, Gravoulet J, Wilcke C, Ruspini E, Birgé J, Boivin JM, Hénard S, Dieterling A, Munerol L, Husson J, Rabaud C, Pulcini C, Malblanc S. Rapid antigen test use for the management of group A streptococcal pharyngitis in community pharmacies. Eur J Clin Microbiol Infect Dis 2018; 37:1637-1645. [PMID: 29876774 DOI: 10.1007/s10096-018-3293-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
Despite group A streptococci being an infrequent cause of pharyngitis in adult outpatients, sore throat remains a common indication for antibiotic prescription. This prospective multicentre non-randomised study describes a community pharmacy-based antimicrobial stewardship intervention consisting in the implementation of rapid antigen testing (RAT) for the management of adults with sore throat. Trained pharmacists triaged patients presenting with symptoms of pharyngitis using the modified Centor score. Those at risk for streptococcal infection were tested with RAT. Patients with a positive RAT were invited to consult a physician, whereas others were offered a symptomatic treatment. All patients received educational leaflets and were asked to fill in a follow-up form 7 days later. Ninety-eight pharmacies in one French region participated, and 559 patients were included over 6 months. RAT was proposed in 367 (65.7%) cases, and it was positive in 28 (8.3%). The follow-up form was returned by 140 (38.5%) participants. Of these, 10/10 patients with positive RAT further consulted a physician and were prescribed an antibiotic treatment, whereas 96.5% (110/114) of patients with negative results and not having any other reason to seek for doctor's advice did not consult. All participants found the intervention useful. Pharmacists spent 6-15 min to perform the intervention, and 98.6% (73/74) of pharmacists giving a feedback declared to be ready to implement this intervention in daily practice, if endorsed and reimbursed. Our results suggest that a pharmacy-based programme for the management of sore throat is feasible and could increase adherence to guidelines.
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Affiliation(s)
- Béatrice Demoré
- Pharmacie Brabois Adultes, CHRU Nancy, Nancy, France.,Université de Lorraine, UMR 7565 (SRSMC) CNRS, Nancy, France.,ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France
| | - Gianpiero Tebano
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France. .,Université de Lorraine, APEMAC, F-54000, Nancy, France.
| | - Julien Gravoulet
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France.,Union Régionale des Professionnels de Santé Pharmaciens du Grand Est, 4 rue Piroux, Nancy, France
| | - Christophe Wilcke
- Union Régionale des Professionnels de Santé Pharmaciens du Grand Est, 4 rue Piroux, Nancy, France
| | - Eric Ruspini
- Union Régionale des Professionnels de Santé Pharmaciens du Grand Est, 4 rue Piroux, Nancy, France
| | - Jacques Birgé
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France
| | - Jean-Marc Boivin
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France
| | - Sandrine Hénard
- Infectious Diseases Department, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Annick Dieterling
- Agence Régionale de Santé du Grand Est. Direction de la Santé Publique, Nancy, France
| | - Lidiana Munerol
- Agence Régionale de Santé du Grand Est. Direction de la Santé Publique, Nancy, France
| | - Julie Husson
- Département Analyse des Données de Santé, Agence Régionale de Santé du Grand Est. Direction de la Qualité et de la Performance, Nancy, France
| | - Christian Rabaud
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France.,Infectious Diseases Department, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Céline Pulcini
- Université de Lorraine, APEMAC, F-54000, Nancy, France.,Infectious Diseases Department, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Sophie Malblanc
- Agence Régionale de Santé du Grand Est. Direction de la Santé Publique, Nancy, France
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8
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Devillers L, Sicsic J, Delbarre A, Le Bel J, Ferrat E, Saint Lary O. General Practitioner trainers prescribe fewer antibiotics in primary care: Evidence from France. PLoS One 2018; 13:e0190522. [PMID: 29370178 PMCID: PMC5784911 DOI: 10.1371/journal.pone.0190522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/15/2017] [Indexed: 02/01/2023] Open
Abstract
Purpose Antibiotic prescription is a central public health issue. Overall, 90% of antibiotic prescriptions are delivered to patients in ambulatory care, and a substantial proportion of these prescriptions could be avoided. General Practitioner (GP) trainers are similar to other GPs in terms of sociodemographic and medical activities, but they may have different prescription patterns. Our aim was to compare the antibiotic prescribing rates between GP trainers and non-trainers. Methods This observational cross-sectional study was conducted on administrative data claims from the French National Health Insurance. The antibiotic prescribing rate was calculated. The main independent variable was the training status of the GPs. Prescribing rates were adjusted for the various GPs’ characteristics (gender, age, location of the practice, number of visits per GP and the case-mix) in a multiple linear regression analysis. Results Between June 2014 and July 2015 the prescribing patterns of 860 GPs were analysed, among which 102 were GP trainers (12%). Over the year 363,580 patients were prescribed an antibiotic out of 3,499,248 visits for 1,299,308 patients seen over the year thus representing around 27.5% of patients. In the multivariate analyses, being a trainer resulted in a significant difference of 6.62 percentage points (IC 95%: [-8.55; -4.69]; p<0.001) in antibiotic prescriptions comparing to being a non-trainer, corresponding to a relative reduction of 23.4%. Conclusion These findings highlight the role of GP trainers in antibiotic prescriptions. By prescribing fewer antibiotics and influencing the next generations of GPs, the human and economic burden of antibiotics could be reduced.
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Affiliation(s)
- Louise Devillers
- Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines (UVSQ), Montigny-le-Bretonneux, France
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
- * E-mail:
| | - Jonathan Sicsic
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Angelique Delbarre
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Josselin Le Bel
- Department of Family Medicine, University Paris Diderot, Sorbonne Paris Cité, Paris, France
- UMR 1137, INSERM, IAME, Paris, France
| | - Emilie Ferrat
- University Paris-Est Créteil (UPEC), School of Medicine, Primary Care Department, Créteil, France
- University Paris-Est Créteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Créteil, France
| | - Olivier Saint Lary
- Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines (UVSQ), Montigny-le-Bretonneux, France
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
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9
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Le Maréchal M, Fressard L, Raude J, Verger P, Pulcini C. General practitioners and vaccination of children presenting with a benign infection. Med Mal Infect 2017; 48:44-52. [PMID: 29113691 DOI: 10.1016/j.medmal.2017.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the self-reported vaccination behavior of general practitioners (GPs) when asked whether they would recommend the vaccination of a child presenting with a febrile uncomplicated common cold. METHODS We performed a cross-sectional survey in 2014 on a national sample of GPs. GPs were randomly assigned to one of eight clinical vignettes, all describing a child presenting with an uncomplicated febrile common cold, but differing by age (4 or 11 months), temperature (38°C or 39°C), and the mother's emotional state (calm or worried). GPs were asked whether they would recommend immediate vaccination of the child with a hexavalent vaccine (diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B), or postpone it. We investigated the relation between the GPs' recommendation to vaccinate, the clinical vignette's variables, and the GPs' perceptions, attitudes, and practices toward vaccination in a multivariate model. RESULTS Among the 1582 participating GPs, 6% recommended immediate vaccination. This behavior was more frequent with a temperature of 38°C rather than 39°C (10% vs. 3%, P<0.001). GPs who felt comfortable giving explanations about vaccine safety were more likely to recommend immediate vaccination of the febrile child (P=0.045), but none of the other GPs' characteristics were associated with their vaccination behavior. CONCLUSIONS Almost all GPs postponed the hexavalent vaccination of the febrile child presenting with an uncomplicated viral disease; fever being the major factor affecting their decision. More research is needed on vaccination responses in sick children, as well as clearer guidelines.
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Affiliation(s)
- M Le Maréchal
- Université de Lorraine, EA 4360 APEMAC, 54000 Nancy, France.
| | - L Fressard
- Aix-Marseille université, UMR_S912, IRD, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France; Inserm, UMR_S912, « Sciences Économiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM), 13000 Marseille, France
| | - J Raude
- EHESP-Rennes, Sorbonne-Paris-Cité, 35043 Rennes, France; Aix-Marseille université, EPV-UMR_D 190 « Émergence des Pathologies Virales », 13000 Marseille, France
| | - P Verger
- Aix-Marseille université, UMR_S912, IRD, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France; Inserm, UMR_S912, « Sciences Économiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM), 13000 Marseille, France; Inserm, F-CRIN, I-Reivac (Innovative clinical research network in vaccinology), 75654 Paris, France
| | - C Pulcini
- Université de Lorraine, EA 4360 APEMAC, 54000 Nancy, France; Inserm, F-CRIN, I-Reivac (Innovative clinical research network in vaccinology), 75654 Paris, France; Service de maladies infectieuses et tropicales, CHRU de Nancy, 54000 Nancy, France
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Kimani FW, Mwangi SM, Kwasa BJ, Kusow AM, Ngugi BK, Chen J, Liu X, Cademartiri R, Thuo MM. Rethinking the Design of Low-Cost Point-of-Care Diagnostic Devices. MICROMACHINES 2017; 8:E317. [PMID: 30400509 PMCID: PMC6190021 DOI: 10.3390/mi8110317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 01/09/2023]
Abstract
Reducing the global diseases burden requires effective diagnosis and treatment. In the developing world, accurate diagnosis can be the most expensive and time-consuming aspect of health care. Healthcare cost can, however, be reduced by use of affordable rapid diagnostic tests (RDTs). In the developed world, low-cost RDTs are being developed in many research laboratories; however, they are not being equally adopted in the developing countries. This disconnect points to a gap in the design philosophy, where parameterization of design variables ignores the most critical component of the system, the point-of-use stakeholders (e.g., doctors, nurses and patients). Herein, we demonstrated that a general focus on reducing cost (i.e., "low-cost"), rather than efficiency and reliability is misguided by the assumption that poverty reduces the value individuals place on their well-being. A case study of clinicians in Kenya showed that "zero-cost" is a low-weight parameter for point-of-use stakeholders, while reliability and standardization are crucial. We therefore argue that a user-driven, value-addition systems-engineering approach is needed for the design of RDTs to enhance adoption and translation into the field.
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Affiliation(s)
- Faith W Kimani
- Kiambu District Hospital, Kiambu 00900, Kenya.
- School of Public Health, Kenyatta University, Nairobi 00100, Kenya.
| | - Samuel M Mwangi
- School of Public Health, Kenyatta University, Nairobi 00100, Kenya.
- Department of Sociology, Kenyatta University, Nairobi 00100, Kenya.
| | - Benjamin J Kwasa
- Department of Aerospace Engineering, Iowa State University, Ames, IA 50011, USA.
| | - Abdi M Kusow
- Department of Sociology, Iowa State University, Ames, IA 00100, USA.
| | - Benjamin K Ngugi
- Department of Information Systems and Operations Management, Suffolk University, Boston, MA 02108, USA.
| | - Jiahao Chen
- Department of Material Science and Engineering, Iowa State University, Ames, IA 50011, USA.
| | - Xinyu Liu
- Department of Mechanical Engineering and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON M5S 3G8, Canada.
| | - Rebecca Cademartiri
- Department of Mechanical Engineering and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON M5S 3G8, Canada.
- Department of Chemical and Biological Engineering, Iowa State University, Ames, IA 50011, USA.
| | - Martin M Thuo
- Department of Mechanical Engineering and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON M5S 3G8, Canada.
- Center for Bioplastics and Biocomposites (CB2), Iowa State University, Ames, IA 50011, USA.
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11
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Toward a Framework for Benefit-Risk Assessment in Diagnostic Imaging: Identifying Scenario-specific Criteria. Acad Radiol 2017; 24:538-549. [PMID: 28372958 DOI: 10.1016/j.acra.2017.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 02/10/2017] [Accepted: 02/11/2017] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES Diagnostic imaging has many effects and there is no common definition of value in diagnostic radiology. As benefit-risk trade-offs are rarely made explicit, it is not clear which framework is used in clinical guideline development. We describe initial steps toward the creation of a benefit-risk framework for diagnostic radiology. MATERIALS AND METHODS We performed a literature search and an online survey of physicians to identify and collect benefit-risk criteria (BRC) relevant to diagnostic imaging tests. We operationalized a process for selection of BRC with the use of four clinical use case scenarios that vary by diagnostic alternatives and clinical indication. Respondent BRC selections were compared across clinical scenarios and between radiologists and nonradiologists. RESULTS Thirty-six BRC were identified and organized into three domains: (1) those that account for differences attributable only to the test or device (n = 17); (2) those that account for clinical management and provider experiences (n = 12); and (3) those that capture patient experience (n = 7). Forty-eight survey participants selected 22 criteria from the initial list in the survey (9-11 per case). Engaging ordering physicians increased the number of criteria selected in each of the four clinical scenarios presented. We developed a process for standardizing selection of BRC in guideline development. CONCLUSION These results suggest that a process relying on elements of comparative effectiveness and the use of standardized BRC may ensure consistent examination of differences among alternatives by way of making explicit implicit trade-offs that otherwise enter the decision-making space and detract from consistency and transparency. These findings also highlight the need for multidisciplinary teams that include input from ordering physicians.
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12
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Strandberg EL, Brorsson A, André M, Gröndal H, Mölstad S, Hedin K. Interacting factors associated with Low antibiotic prescribing for respiratory tract infections in primary health care - a mixed methods study in Sweden. BMC FAMILY PRACTICE 2016; 17:78. [PMID: 27430895 PMCID: PMC4950701 DOI: 10.1186/s12875-016-0494-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/13/2016] [Indexed: 11/12/2022]
Abstract
Background Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. Methods Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners’ audit registrations. Qualitative data were collected through observations and semi-structured interviews. Results From the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioner’s diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual. Conclusions Low prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses’ triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged for up-to-date knowledge.
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Affiliation(s)
- Eva Lena Strandberg
- Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Malmö, Sweden. .,Blekinge Centre of Competence, Blekinge County Council, Karlskrona, Sweden.
| | - Annika Brorsson
- Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Malmö, Sweden.,Center for Primary Health Care Research, Malmö, Skåne Region, Sweden
| | - Malin André
- Department of Medicine and Health Sciences, Family Medicine, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences - Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Hedvig Gröndal
- Department of Sociology Uppsala, Uppsala University, Uppsala, Sweden
| | - Sigvard Mölstad
- Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Katarina Hedin
- Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Malmö, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
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13
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Boccardi M, Altomare D, Ferrari C, Festari C, Antelmi L, Pievani M, Tarallo A, Muscio C, Guerra UP, Paghera B, Padovani A, Frisoni GB. Do Beliefs about the Pathogenetic Role of Amyloid Affect the Interpretation of Amyloid PET in the Clinic? NEURODEGENER DIS 2015; 16:111-7. [DOI: 10.1159/000439255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/07/2015] [Indexed: 11/19/2022] Open
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14
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Le Maréchal M, Collange F, Fressard L, Peretti-Watel P, Sebbah R, Mikol F, Agamaliyev E, Gautier A, Pulcini C, Verger P. Design of a national and regional survey among French general practitioners and method of the first wave of survey dedicated to vaccination. Med Mal Infect 2015; 45:403-10. [PMID: 26494319 DOI: 10.1016/j.medmal.2015.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 07/20/2015] [Accepted: 09/10/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES France is currently facing a vaccine-hesitancy crisis. We conducted a questionnaire-based telephone interview with a large sample of general practitioners (GPs) as they play a crucial role in the vaccination process. Our main objectives were to study the GPs' vaccination behaviors when it comes to their own vaccination and that of their relatives, and the vaccine recommendations made to their patients. We also aimed to understand their opinion related to the severity of vaccine-preventable diseases and to assess their trust in various sources of information. Finally, we enquired about their opinion in terms of vaccination-related tools that could help them in their daily practice. The article aimed to present the design of this panel and survey. PATIENTS AND METHODS Four samples of GPs (one national and three regional) were selected among all the French GPs (metropolitan France) using random sampling. Five cross-sectional surveys should be conducted with that panel. The mean targeted sample size is 2350 GPs for each survey. The survey dedicated to vaccination was conducted by telephone or on the Internet. RESULTS GPs were included in the survey between December 2013 and February 2014. The national sample included 1582 GPs (response rate: 46%) and the three regional samples included 1297 GPs (response rate: 44%). The survey dedicated to vaccination was conducted between April and July 2014; the national sample response rate was 92% (1582/1712). CONCLUSION The results of the first wave of surveys, conducted on a large sample of French GPs, provide important information to guide the French vaccination policy.
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Affiliation(s)
- M Le Maréchal
- EA4360APEMAC, université de Lorraine, université Paris-Descartes, 54000 Nancy, France
| | - F Collange
- UMR912 (SESSTIM), Inserm, 13000 Marseille, France; UMR_S912, IRD, Aix-Marseille université, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France
| | - L Fressard
- UMR912 (SESSTIM), Inserm, 13000 Marseille, France; UMR_S912, IRD, Aix-Marseille université, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France
| | - P Peretti-Watel
- UMR912 (SESSTIM), Inserm, 13000 Marseille, France; UMR_S912, IRD, Aix-Marseille université, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France
| | - R Sebbah
- Union régionale des professionnels de santé - médecins libéraux (URPS-ML) PACA, 37/39, boulevard Vincent-Delpuech, 13006 Marseille, France
| | - F Mikol
- Bureau des professions de santé, DREES, ministère des Affaires sociales, de la Santé et des Droits des femmes, 14, avenue Duquesne, 75350 Paris 07 SP, France
| | - E Agamaliyev
- Bureau des professions de santé, DREES, ministère des Affaires sociales, de la Santé et des Droits des femmes, 14, avenue Duquesne, 75350 Paris 07 SP, France
| | - A Gautier
- Institut national de prévention et d'éducation pour la santé, direction des affaires scientifiques, 42, boulevard de la Libération, 93203 Saint-Denis cedex, France
| | - C Pulcini
- EA4360APEMAC, université de Lorraine, université Paris-Descartes, 54000 Nancy, France; Service de maladies infectieuses et tropicales, bâtiment des spécialités médicales, hôpitaux de Brabois, CHU de Nancy, allée du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
| | - P Verger
- UMR912 (SESSTIM), Inserm, 13000 Marseille, France; UMR_S912, IRD, Aix-Marseille université, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France; Inserm, F-CRIN, I-Reivac, immeuble AROPA, 35, rue Bernard-de-Ventadour, 31300 Toulouse, France
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15
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[Prospective cross-sectional study of antibiotic prescriptions in a sample of French general practitioners]. Presse Med 2015; 44:e59-66. [PMID: 25650299 DOI: 10.1016/j.lpm.2014.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 06/19/2014] [Accepted: 07/03/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The aim of our study was to assess the quality of antibiotic prescriptions in a sample of general practitioners (GPs) receiving junior doctors in training, whatever the motive of the prescription. METHODS We performed a prospective observational study of all antibiotics prescribed in October 2012 by 21 GPs working in southeastern France. Two specialists (general medicine and infectious diseases) independently assessed the compliance with recommendations of antibiotic prescriptions using a validated algorithm. RESULTS Two hundred and thirty-two antibiotic courses were prescribed, mainly for low respiratory tract infections (30%), ENT (26%), urinary tract (22%) or skin (13%) infections. Forty prescriptions were considered as appropriate (17%), 77 as inappropriate (33%; mainly due to a non-recommended molecule choice [77%] or a too long treatment duration [44%]) and 115 prescriptions were unnecessary (50%), due to diagnostic issues. There were wide variations between GPs. An essential laboratory or imaging investigation was missing for 36% of prescriptions: chest X-ray for pneumonia (80% were missing), rapid antigen diagnostic test for acute pharyngitis (23% missing) and urine dipstick for urinary tract infections (80% missing). Fluoroquinolones and macrolides/synergistins accounted for 31% of the prescriptions, and were associated with a lower prevalence of appropriate prescriptions (7% and 2% respectively, P<0.001). There was a co-prescription of anti-inflammatory drugs in 15% of the cases. CONCLUSION The misuse of antibiotics was frequent in this study. Improving the diagnostic workout is of paramount importance. Urgent actions are needed to improve antibiotic use in general practice.
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Anjos LMM, Marcondes MB, Lima MF, Mondelli AL, Okoshi MP. Streptococcal acute pharyngitis. Rev Soc Bras Med Trop 2014; 47:409-13. [DOI: 10.1590/0037-8682-0265-2013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/29/2014] [Indexed: 11/22/2022] Open
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17
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Michel-Lepage A, Ventelou B, Verger P, Pulcini C. Factors associated with the use of rapid antigen diagnostic tests in children presenting with acute pharyngitis among French general practitioners. Eur J Clin Microbiol Infect Dis 2013; 33:723-8. [PMID: 24173821 DOI: 10.1007/s10096-013-2003-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/16/2013] [Indexed: 11/26/2022]
Abstract
In this investigation, we wanted: (i) to describe the attitudes and declared practices of a representative sample of French general practitioners (GPs) regarding rapid antigen diagnostic tests (RADTs) for acute pharyngitis and (ii) to identify the GPs' characteristics associated with the use of an RADT in the last paediatric patient with pharyngitis. We performed a cross-sectional survey conducted in 2012 among a representative sample of 1,126 self-employed GPs in France. 60.1 % of GPs declared that they used an RADT in their last patient aged between 3 and 16 years presenting with acute pharyngitis; 29.6 % of these tests were positive. Among the GPs who did not use an RADT, 50.2 % prescribed an antibiotic, compared to 30.5 % of prescriptions among GPs who performed an RADT, whatever its result. In a multivariate analysis, GPs' age between 45 and 54 years and having attended Continuing Medical Education (CME) sessions on infectious diseases in the past year were significantly associated with an increased use of an RADT in the last patient with pharyngitis, whereas a low volume of activity, occasionally practising alternative medicine, receiving pharmaceutical representatives at the practice and declaring a consultation duration <15 min were factors associated with a decreased use of RADTs. The use of RADTs by GPs must be promoted; our findings could help define interventions to improve practice.
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Affiliation(s)
- A Michel-Lepage
- Aix Marseille Université (Aix Marseille School of Economics-SESSTIM UMR 912, Inserm IRD), Marseille, France
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18
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Michel-Lepage A, Ventelou B, Nebout A, Verger P, Pulcini C. Cross-sectional survey: risk-averse French GPs use more rapid-antigen diagnostic tests in tonsillitis in children. BMJ Open 2013; 3:e003540. [PMID: 24163205 PMCID: PMC3808757 DOI: 10.1136/bmjopen-2013-003540] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES We tested the following hypotheses: (1) risk-averse general practitioners (GPs) might use more Rapid Antigen Diagnostic Tests (RADTs) in tonsillitis in children, probably to decrease their diagnostic uncertainty regarding the aetiology of the disease (viral vs due to group A Streptococcus); and (2) GPs not using RADT might prescribe more antibiotics when they are risk averse. DESIGN, SETTING AND PARTICIPANTS We conducted a cross-sectional survey of a nationwide French representative sample of 1093 GPs in 2012. OUTCOME MEASURES Multivariate analyses adjusted on the four stratification variables (age, gender, location and volume of activity, ie, the number of annual consultations) were performed to identify the risk domains associated with indicators of good or poor practice. RESULTS 69.4% of GPs were aware of national guidelines regarding tonsillitis and declared that they had taken these guidelines into account for their last paediatric tonsillitis case. 59.1% declared they used RADT in their last patient aged between 3 and 16 years presenting with tonsillitis; 29.7% of these tests were positive. Among the GPs who used RADT, 30.7% prescribed an antibiotic; 98.3% did either prescribe an antibiotic because of a positive RADT result, or did not prescribe an antibiotic in view of a negative result. Among the GPs who did not use RADT, 50.7% prescribed an antibiotic. In multivariate analyses, risk-averse GPs declared being more aware of and compliant with guidelines (OR=1.56, p<0.01), and used RADTs more often for their last patient (OR=1.30, p<0.05). Among GPs not using RADT in their last patient, risk-averse GPs prescribed more antibiotics compared with risk-tolerant doctors (OR=1.18, p<0.05). CONCLUSIONS Individual risk attitudes influenced GPs' practices in tonsillitis, particularly the use of RADTs and antibiotic prescriptions.
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Affiliation(s)
- Audrey Michel-Lepage
- Aix Marseille Université (Aix Marseille School of Economics—SESSTIM UMR 912, Inserm IRD), Marseille, France
- IHU, Fondation Méditerranée Infection, Marseille, France
| | - Bruno Ventelou
- Aix Marseille Université (Aix Marseille School of Economics—SESSTIM UMR 912, Inserm IRD), Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
- CNRS, U6579 (greqam), Marseille, France
| | - Antoine Nebout
- Aix Marseille Université (Aix Marseille School of Economics—SESSTIM UMR 912, Inserm IRD), Marseille, France
- INRA, UR 1303 ALISS, F-94200 Ivry-sur-Seine, France
| | - Pierre Verger
- Aix Marseille Université (Aix Marseille School of Economics—SESSTIM UMR 912, Inserm IRD), Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Céline Pulcini
- Aix Marseille Université (Aix Marseille School of Economics—SESSTIM UMR 912, Inserm IRD), Marseille, France
- Service d'Infectiologie, CHU de Nice, Nice, France
- Faculté de Médecine, Université Nice-Sophia Antipolis, Nice, France
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Park M, Hue V, Dubos F, Lagrée M, Pruvost I, Martinot A. [Reasons for low usage of strep A rapid antigen detection tests for pharyngitis in private medical practice]. Arch Pediatr 2013; 20:1083-8. [PMID: 23932873 DOI: 10.1016/j.arcped.2013.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 05/25/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Rapid group A Streptococcus (GAS) antigen detection tests (RDT) have high diagnostic performance for the management of acute pharyngitis and are recommended before any antibiotic (ATB) prescription in France to reduce ATB use. The rate of general practitioners (GPs) using GAS RDT is low and decreasing. Our aims were to describe the reasons for pediatricians and GPs not using RDT or for prescribing ATB despite of a negative RDT. METHODS In 2011, a survey was conducted in a random sample of 368 GPs plus all ambulatory pediatricians (n=82) in the Nord-Pas-de-Calais region of France. RESULTS Response rates were 74% (n=61) for pediatricians and 18% (n=68) for GPs. RDTs for pharyngitis were used by 75% [95% CI: 63-85] of pediatricians and 53% [95% CI: 41-64] of GPs (P<0.001). RDTs were systematically used in children 3years of age and older by only 59% of all physicians using RDTs. An ATB was systematically prescribed in case of positive RDT by 96% of physicians and eventually prescribed in case of negative RDT by 74%. The main reasons for ATB prescription in case of negative RDT were association with otitis media (51%), second visit for the same pharyngitis (45%), and high clinical suspicion of GAS pharyngitis (36%). Forty percent of non-RDT users had used them in the past. The 3 main reasons for not using RDT were the lack of time (57%), high confidence in clinical data to discriminate GAS pharyngitis (48%), and low confidence in RDT (27%). DISCUSSION This survey highlights the lack of knowledge about low and high discriminant values of clinical data and RDT, respectively, especially the excellent negative predictive value of RDTs, and an erroneous assessment of the low risk of missing GAS pharyngitis compared to the consequences of inappropriate ATB use.
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Affiliation(s)
- M Park
- Urgences pédiatriques, pôle urgence, CHRU Lille, 59000 Lille, France
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Pulcini C, Massin S, Launay O, Verger P. Knowledge, attitudes, beliefs and practices of general practitioners towards measles and MMR vaccination in southeastern France in 2012. Clin Microbiol Infect 2013; 20:38-43. [PMID: 23517454 DOI: 10.1111/1469-0691.12194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/31/2013] [Accepted: 02/11/2013] [Indexed: 11/30/2022]
Abstract
As a result of sub-optimal immunization levels, measles has re-emerged in the EU since 2008 (30 ,567 cases in 2011), and nearly half of the cases reported are in France. Our objectives were to assess knowledge, attitudes, beliefs and practices of French general practitioners (GPs) towards measles and measles-mumps-rubella (MMR) vaccination. In 2012, we surveyed 329 GPs in southeastern France. Forty-five percent reported that they saw patients with measles in 2011. They considered the risk of complications low among 2-5-year-old children and young adults without co-morbidity. Twenty percent knew that two MMR doses are 99% effective in preventing measles. Nearly all (95%) GPs stated that they verified the MMR status for patients <30 years old in 2011 (42% systematically, 37% often, 15% sometimes). Seventy-nine percent reported proposing MMR vaccination to non-immune relatives in contact with a patient with measles. Participation in continuing medical education courses and considering measles to be a serious disease were independently associated with such post-exposure vaccination. GPs considered the following were potential barriers to the second dose of MMR (MMR2): parents/patients' belief that measles is harmless (80%), parents/patients' fear of the vaccine's side effects (50%), difficulty in documenting vaccination (48%) and lack of reminders for MMR2 (16%). Finally, some GPs also had misconceptions about the severity of measles (13%) and the usefulness of MMR2 (12%), which also served as barriers. In conclusion, it is essential to raise GPs' awareness of this disease and fill any gaps in their knowledge, by providing them with evidence-based information on measles and MMR vaccination.
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Affiliation(s)
- C Pulcini
- UMR912 (SESSTIM), INSERM, Marseille, France; Service d'Infectiologie, CHU de Nice, Nice, France; Faculté de Médecine, Université Nice-Sophia Antipolis, Nice, France
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