A qualitative study of GP, NP and patient views about the use of rapid streptococcal antigen detection tests (RADTs) in primary care: ‘swamped with sore throats?’

Abstract

ObjectiveTo explore patient and healthcare professionals’ (HCP) views of clinical scores and rapid streptococcal antigen detection tests (RADTs) for acute sore throat.DesignQualitative semistructured interview study.SettingUK primary care.ParticipantsGeneral practitioners (GPs), nurse practitioners (NPs) and patients from general practices across Hampshire, Oxfordshire and the West Midlands who were participating in the Primary Care Streptococcal Management (PRISM) study.MethodSemistructured, face-to-face and phone interviews were conducted with GPs, NPs and patients from general practices across Hampshire, Oxfordshire and the West Midlands.Results51 participants took part in the study. Of these, 42 were HCPs (29 GPs and 13 NPs) and 9 were patients. HCPs could see a positive role for RADTs in terms of reassurance, as an educational tool for patients, and for aiding inexperienced practitioners, but also had major concerns about RADT use in clinical practice. Particular concerns included the validity of the tests (the role of other bacteria, and carrier states), the tension and possible disconnect with clinical assessment and intuition, the issues of time and resource use and the potential for medicalisation of self-limiting illness. In contrast, however, experience of using RADTs over time seemed to make some participants more positive about using the tests. Moreover, patients were much more positive about the place of RADTs in providing reassurance and in limiting their antibiotic use.ConclusionsIt is unlikely that RADTs will have a (comfortable) place in clinical practice in the near future until health professionals’ concerns are met, and they have direct experience of using them. The routine use of clinical scoring systems for acute upper respiratory illness also face important barriers related to clinicians’ perceptions of their utility in the face of clinician experience and intuition.

Cross-sectional survey: risk-averse French GPs use more rapid-antigen diagnostic tests in tonsillitis in children

“…It is possible that the diagnostic uncertainty leading to unnecessary antibiotic prescriptions in tonsillitis leaves room for an increased use of RADTs and, as a consequence, for a decreased use of antibiotics in risk-averse GPs using RADT. RADTs may indeed decrease diagnostic uncertainty, as suggested in the literature 6–9 12. RADTs allow the physician to differentiate between viral and bacterial (group A streptococcal infection) tonsillitis, whereas clinical findings do not allow a reliable distinction to be made between viral and bacterial tonsillitis 3.…”

Clinicians’ Views and Experiences of Interventions to Enhance the Quality of Antibiotic Prescribing for Acute Respiratory Tract Infections

“…5,20 A more recent study found that UK clinicians were initially skeptical about the use of POCTs and experienced problems using them in practice; however, over time these issues diminished. 21 A third study 22 identified that clinicians' preferences for interventions changed after having experience in using the interventions. Clinicians initially favoured POCTs over communication skills; however, they reversed their preference after trials of both.…”

“…The STAR study evaluated a multifaceted educational intervention delivered through both online and outreach visit training, and was centred on communication skills. [16][17][18][19][20][21][22][23][24][25][26] Clinicians reported that communication skills training gave them an additional insight into their patients' agendas, which they felt would reduce future unnecessary consultations, but required an initial investment of longer consultations. The current study found that only a minority of clinicians specifically mentioned the advantage of the communication skills and most concentrated on the benefits of the patient booklet.…”

Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography

“…Moreover, PCPs belonging in this group typically saw interventions as too costly or too time consuming to fit into usual practice: In the last cell, 'Interventions as unnecessary', PCPs choose not to integrate interventions into their own practice, but to accept their utility for other, mostly inexperienced, groups of prescribers. Specifically, this was the case with certain PCPs who reported that, although interventions were unnecessary for them, they did have 'a place within primary care', 38 as they could prove a useful tool for inexperienced practitioners (for example, newly qualified GPs) or new prescribers (for example, nurses).…”