title: Perceptions and attitudes of French general practitioners towards rapid antigen diagnostic tests in acute pharyngitis using a randomized case vignette study.
abstract: OBJECTIVE
  This study had three objectives: (i) to assess the use of rapid antigen diagnostic tests (RADTs) and their impact on the antibiotic prescribing behaviour of general practitioners (GPs) for acute pharyngitis; (ii) to study the barriers to the use of RADTs; and (iii) to identify GPs' characteristics associated with non-compliance with French guidelines.
  
  
  METHODS
  We conducted a cross-sectional survey of a representative sample of 369 self-employed GPs in south-eastern France using a randomized case vignette study.
  
  
  RESULTS
  The availability of an RADT allowed a 44% relative reduction in the rate of antibiotic prescriptions. Of GPs for whom the test was available, 34% did not use an RADT in our acute pharyngitis vignette and 13% of those who used the test prescribed an antibiotic despite a negative RADT result. Non-compliance with French guidelines (i.e. not using an RADT and/or prescribing an antibiotic despite a negative RADT result) was independently associated with the following factors: less reading of medical journals, less benefits/risks discussion with patients about vaccinations and higher perception that clinical examination was sufficient to prescribe antibiotics. The three main declared barriers to RADT use were: time to perform the test, patient expectations regarding antibiotics and the perception that clinical examination was sufficient to decide to prescribe an antibiotic.
  
  
  CONCLUSIONS
  RADTs are a useful but not sufficient tool to reduce antibiotic prescribing in general practice. The results of this study increase understanding of the factors underlying clinical decision making for acute pharyngitis and may contribute to the development of interventions to improve practice.
authors.affiliation: Centre Hospitalier Universitaire de Nice, Service d'Infectiologie, Nice, France. pulcini.c@chu-nice.fr
authors.forename: Céline
authors.initials: C
authors.lastname: Pulcini
authors.forename: Laure
authors.initials: L
authors.lastname: Pauvif
authors.forename: Alain
authors.initials: A
authors.lastname: Paraponaris
authors.forename: Pierre
authors.initials: P
authors.lastname: Verger
authors.forename: Bruno
authors.initials: B
authors.lastname: Ventelou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000942:Antigens, Bacterial / Q000032:analysis*; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005602:France; D058005:General Practitioners; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007118:Immunoassay / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000942:Antigens, Bacterial