title: Evaluation of the implementation of a rapid streptococcal antigen test in a routine primary health care setting: from recommendations to practice.
abstract: OBJECTIVE
  Pharyngitis is a common reason for consultation in General Practice. Despite the development of diagnostic criteria it remains difficult to clinically diagnose the bacterial type. Therefore, current guidelines recommend the additional use of objective tests. In Austria, the Burgenländische Gebietskrankenkasse introduced a test as service for patients and regular payment position for GPs. It was the aim of this study to analyze this implementation process in General Practice and a possible change in antibiotic prescriptions.
  
  
  METHODS
  The retrospective evaluation lasted from April 2006 to September 2009; in April 2007, rapid-streptococcal-antigen-tests (RSATs) were introduced. GPs were grouped into three clusters according to their use of RSATs. In addition, all antibiotic prescriptions within the evaluation period were analyzed and correlated to the three clusters before and after the implementation.
  
  
  RESULTS
  The overall number of RSATs performed was 6,401. Half of the GPs utilized it regularly. After its introduction, the relative antibiotic prescription frequency was significantly reduced (17.1 vs. 16.4 %, p = 0.0001). The results for the subgroup analyses yielded a significant reduction for the regular user group only (16.0 vs. 15.0 %, p = 0.0001).
  
  
  CONCLUSIONS
  GPs using the RSAT regularly seem to apply the test appropriately. The decrease of the relative antibiotic prescriptions of all GPs seems to be due to the regular user group of GPs. This could be interpreted as a consequence of the RSAT use. The results show a positive trend for an improvement in diagnostic quality and for an appropriate use of antibiotic prescriptions.
authors.affiliation: Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Waehringerstr. 1090, Vienna, Austria. kathryn.hoffmann@meduniwien.ac.at
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hoffmann
authors.forename: Berthold
authors.initials: B
authors.lastname: Reichardt
authors.forename: Sonja
authors.initials: S
authors.lastname: Zehetmayer
authors.forename: Manfred
authors.initials: M
authors.lastname: Maier
mesh_terms: D000942:Antigens, Bacterial / Q000276:immunology; D001317:Austria / Q000453:epidemiology; D042241:Early Diagnosis; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007159:Immunologic Tests / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D000942:Antigens, Bacterial