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Management of patients with sore throats in relation to guidelines: an interview study in Sweden
Katarina Hedin1, Eva Lena Strandberg, Hedvig Gröndal
1Department of Clinical Sciences, Malmö, Family Medicine, Lund University , Sweden.
Objective:
To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews.
Design:
Qualitative content analysis was used to analyse semi-structured interviews.
Setting:
Swedish primary care.
Subjects:
A strategic sample of 25 GPs.
Main Outcome Measures:
Perceived management of sore throat patients.
Results:
It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identified and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs.
Conclusion:
This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.
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