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Diagnosing streptococcal sore throat in adults: randomized controlled trial of in-office aids
Graham Worrall1, James Hutchinson, Gregory Sherman
1Memorial University of Newfoundland, St John's. gworrall@mun.ca
Objective:
To determine whether use of clinical decision rules or rapid streptococcal antigen detection tests (alone or in combination) can lower the number of unnecessary prescriptions for antibiotics for adults with acute sore throats.
Design:
Four-arm randomized controlled trial.
Setting:
Family practice offices in eastern Newfoundland.
Participants:
Forty urban and suburban family practitioners.
Interventions:
Participants were randomly assigned to one of 4 arms (usual practice, decision rules only, rapid antigen test only, decision rules and antigen test combined), and each recruited successive adult patients presenting with acute sore throat as their main symptom. Following usual care or use of decision rules or rapid antigen tests or both (where applicable), physicians were to record what they prescribed for each patient.
Main Outcome Measures:
Prescribing rates and types of antibiotics prescribed.
Results:
The prescribing rate using decision rules (55%) did not differ significantly from the rate using usual clinical practice (58%). Physicians using rapid antigen tests, both alone and with decision rules, had significantly lower prescribing rates (27% and 38%, respectively, both P < .001).
Conclusion:
Evidence-based clinical decision rules alone do not change family doctors' prescribing behaviour. Use of rapid antigen tests might allow physicians to persuade patients that negative results (and hence, viral infection) mean antibiotic therapy is not required.
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