Clinicians usually do not follow guidelines for adult pharyngitis
NEW YORK (Reuters Health) – In treating adult patients with pharyngitis, the problem is not which guidelines primary care practitioners use but that they often don’t follow any guidelines, Harvard investigators assert in the July 10th issue of the Archives of Internal Medicine.
Dr. Jeffrey A. Linder and others at Brigham and Women’s Hospital and Harvard University in Boston, Massachusetts, set out to measure clinician adherence to any of three sets of treatment guidelines for adult pharyngitis. They conducted a retrospective analysis of visits by 2,097 adults to nine Boston-area primary care clinics.
| “Clinicians were adherent to the American College of Physicians’ empirical strategy in 12% of visits, the American College of Physicians’ test strategy in 30% of visits, the Infectious Diseases Society of America’s strategy in 30% of visits, and adherent to none in 66% of visits,” the team found.   Â
The most common reason for nonadherence to treatment guidelines was testing or prescribing of antibiotics to adults at low risk of streptococcal pharyngitis, but there could be a number of other possibilities, Dr. Linder told Reuters Health. |
“Clinicians may not be aware of the guidelines or if familiar with them, may disagree with, not be motivated to adhere to the guidelines,” he said, “or clinicians may be affected by external barriers like time pressures (it is quicker to just prescribe an antibiotic than to explain to a patient why antibiotics are not necessary) or patient insistence that they receive a test or an antibiotic. ”
The majority of clinicians are probably treating their patients empirically, Dr. Linder suspects. “In addition to educating clinicians about appropriate testing and antibiotic prescribing for adults with pharyngitis, there is a role for patient education as well.”
Only about 10% of adults with sore throat will have strep throat, so “the patient should expect to not get antibiotics when they see the doctor for sore throat. Most patients will probably not even need to have a streptococcal test,” he pointed out.
“It was interesting to me … that 30% of patients who had a negative streptococcal test still got antibiotics,” Dr. Linder commented. “This raises the question as to why the clinicians even did the test in the first place.”
In an editorial, Drs. Robert M. Centor and Stuart James Cohen of the University of Alabama, Birmingham, add that not only was a significant subset prescribed an antibiotic with a negative test, another 40% received the incorrect antibiotic.
They say it is more important to change physicians’ treatment of mild pharyngitis than to focus on practice patterns in severe pharyngitis.
Arch Intern Med 2006;166:1345-1346, 1374-1379.
Click here for the clinical guidelines on antibiotics usage in pharyngitis.
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