title: Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat - a qualitative interview study.
abstract: BACKGROUND
  Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended with 2-4 Centor criteria present and antibiotics were recommended if the test was positive. C- reactive protein (CRP) was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies.
  
  
  METHODS
  From a larger project 16 general practitioners (GPs) who stated management of sore throats not according to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the management of sore throats and the use of near-patient tests. Qualitative content analysis was used.
  
  
  RESULTS
  The use of the near-patient test interplayed with the clinical assessment and the perception that all infections caused by bacteria should be treated with antibiotics. The GPs expressed a belief that the clinical picture was sufficient for diagnosis in typical cases. RADT was not believed to be relevant since it detects only one bacterium, while CRP was considered as a reliable numerical measure of bacterial infection.
  
  
  CONCLUSIONS
  Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge. When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.
authors.affiliation: Department of Sociology, Uppsala University, Uppsala, Sweden. hedvig.grondal@soc.uu.se.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Gröndal
authors.affiliation: Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Lund, Sweden. katarina.hedin@kronoberg.se.|Department of Research and Development, Region Kronoberg, Växjö, Sweden. katarina.hedin@kronoberg.se.
authors.forename: Katarina
authors.initials: K
authors.lastname: Hedin
authors.affiliation: Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Lund, Sweden. eva-lena.strandberg@med.lu.se.|Blekinge Centre of Competence, Blekinge County Council, Karlskrona, Sweden. eva-lena.strandberg@med.lu.se.
authors.forename: Eva Lena
authors.initials: EL
authors.lastname: Strandberg
authors.affiliation: Department of Medicine and Health Sciences, Family Medicine, Linköping University, Linköping, Sweden. malin.e.andre@gmail.com.|Department of Public Health and Caring Sciences - Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden. malin.e.andre@gmail.com.
authors.forename: Malin
authors.initials: M
authors.lastname: André
authors.affiliation: Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Lund, Sweden. annika.brorsson@med.lu.se.|Center for Primary Health Care Research, Skåne Region, Malmö, Sweden. annika.brorsson@med.lu.se.
authors.forename: Annika
authors.initials: A
authors.lastname: Brorsson
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D019468:Disease Management; D005260:Female; D058005:General Practitioners / Q000523:psychology / Q000592:standards / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007159:Immunologic Tests / Q000379:methods / Q000706:statistics & numerical data; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D000067716:Point-of-Care Testing / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D013297:Streptococcus pyogenes / Q000276:immunology / Q000302:isolation & purification; D013548:Sweden; D063189:Symptom Assessment
chemical_list: D000900:Anti-Bacterial Agents