[Sore throat consultation--what is the value of a treatment guideline?].
OBJECTIVE
To investigate the possibility of rationalizing the management of sore throat in the doctor's office with the aid of appropriate guidelines.


METHODS
Part 1 was designed as a retrospective study involving two comparative groups: A1 under the care of general practitioner (GP) A, and B1 under the care of GP B. Part 2 was designed as a randomized prospective study involving two comparative groups and intervention: A2 under the care of GP A with no intervention, and B2 treated by GP B with intervention. The study was conducted in the group practice of the two GPs, located in a middle-sized town. Guidelines for the differential management of sore throat was developed. An overall total of 1010 patients with sore throat were divided into 4 groups, and their epidemiological data, care criteria (throat swabs, antibiotics) and effectiveness criteria (success rate, relapses) evaluated statistically using the Instat Guide program to identify guideline-influenced effects.


RESULTS
No significant differences were to be seen between the three groups receiving routine care. In the guideline-oriented group, however, significant changes were observed (P < 0.01): more frequent identification of viral pharyngitis in comparison with other underlying clinical causes, a decrease in the frequency of throat swabs from 32% to 7%, and a decrease in the use of antibiotics from 51% to 31%, with the success and relapse rates remaining virtually unchanged.


CONCLUSIONS
The implementation of the guidelines results in the avoidance of unnecessary diagnostic measures and the overuse of antibiotics, while ensuring high-quality care and a high level of feasibility in the day-to-day work of the doctor's office.
Medizinische Poliklinik der LMU München. hbarwitz@t-online.de
H J
HJ
Barwitz
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents