title: Cross-sectional survey: risk-averse French GPs use more rapid-antigen diagnostic tests in tonsillitis in children.
abstract: OBJECTIVE
  We tested the following hypotheses: (1) risk-averse general practitioners (GPs) might use more Rapid Antigen Diagnostic Tests (RADTs) in tonsillitis in children, probably to decrease their diagnostic uncertainty regarding the aetiology of the disease (viral vs due to group A Streptococcus); and (2) GPs not using RADT might prescribe more antibiotics when they are risk averse.
  
  
  METHODS
  We conducted a cross-sectional survey of a nationwide French representative sample of 1093 GPs in 2012.
  
  
  METHODS
  Multivariate analyses adjusted on the four stratification variables (age, gender, location and volume of activity, ie, the number of annual consultations) were performed to identify the risk domains associated with indicators of good or poor practice.
  
  
  RESULTS
  69.4% of GPs were aware of national guidelines regarding tonsillitis and declared that they had taken these guidelines into account for their last paediatric tonsillitis case. 59.1% declared they used RADT in their last patient aged between 3 and 16 years presenting with tonsillitis; 29.7% of these tests were positive. Among the GPs who used RADT, 30.7% prescribed an antibiotic; 98.3% did either prescribe an antibiotic because of a positive RADT result, or did not prescribe an antibiotic in view of a negative result. Among the GPs who did not use RADT, 50.7% prescribed an antibiotic. In multivariate analyses, risk-averse GPs declared being more aware of and compliant with guidelines (OR=1.56, p<0.01), and used RADTs more often for their last patient (OR=1.30, p<0.05). Among GPs not using RADT in their last patient, risk-averse GPs prescribed more antibiotics compared with risk-tolerant doctors (OR=1.18, p<0.05).
  
  
  CONCLUSIONS
  Individual risk attitudes influenced GPs' practices in tonsillitis, particularly the use of RADTs and antibiotic prescriptions.
authors.affiliation: Aix Marseille Université (Aix Marseille School of Economics-SESSTIM UMR 912, Inserm IRD), Marseille, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Michel-Lepage
authors.forename: Bruno
authors.initials: B
authors.lastname: Ventelou
authors.forename: Antoine
authors.initials: A
authors.lastname: Nebout
authors.forename: Pierre
authors.initials: P
authors.lastname: Verger
authors.forename: Céline
authors.initials: C
authors.lastname: Pulcini
keywords: INFECTIOUS DISEASES; PRIMARY CARE