Uncertainty in clinical practice - An interview study with Swedish GPS on patients with sore throat
(2016) In BMC Family Practice 17(1).- Abstract
Background: Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines. Methods: An interview study was conducted among a strategic sample of 25 general practitioners (GPS). Results: All GPS mentioned potential dangerous differential diagnoses and complications. Four... (More)
Background: Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines. Methods: An interview study was conducted among a strategic sample of 25 general practitioners (GPS). Results: All GPS mentioned potential dangerous differential diagnoses and complications. Four strategies for coping with uncertainty were identified, one of which was compliant with guidelines, "Adherence to guidelines", and three were idiosyncratic: "Clinical picture and C-reactive protein (CRP)", "Expanded control", and "Unstructured". The residual uncertainty differed for the different strategies: in the strategy "Adherence to guidelines" and "Clinical picture and CRP" uncertainty was avoided, based either on adherence to guidelines or on the clinical picture and near-patient CRP; in the strategy "Expanded control" uncertainty was balanced based on expanded control; and in the strategy "Unstructured" uncertainty prevailed in spite of redundant examination and anamnesis. Conclusion: The majority of the GPS avoided uncertainty and deemed they had no problems. Their strategies either adhered to guidelines or comprised excessive use of tests. Thus use of guidelines as well as use of more near-patient tests seemed associated to reduced uncertainty, although the later strategy at the expense of compliance to guidelines. A few GPS did not manage to cope with uncertainty or had to put in excessive work to control uncertainty.
(Less)
- author
- Andre, Malin ; Gröndal, Hedvig ; Strandberg, Eva Lena LU ; Brorsson, Annika LU and Hedin, Katarina LU
- organization
- publishing date
- 2016-05-18
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- C-reactive protein, General practitioners, Guideline, Qualitative research, Sore throat, Uncertainty
- in
- BMC Family Practice
- volume
- 17
- issue
- 1
- article number
- 56
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:27188438
- wos:000375989200001
- scopus:84969134529
- ISSN
- 1471-2296
- DOI
- 10.1186/s12875-016-0452-9
- language
- English
- LU publication?
- yes
- id
- f8b865e9-87f2-4303-ae5e-f84c330d41f2
- date added to LUP
- 2016-05-31 15:01:28
- date last changed
- 2024-03-22 03:09:02
@article{f8b865e9-87f2-4303-ae5e-f84c330d41f2,
abstract = {{<p>Background: Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines. Methods: An interview study was conducted among a strategic sample of 25 general practitioners (GPS). Results: All GPS mentioned potential dangerous differential diagnoses and complications. Four strategies for coping with uncertainty were identified, one of which was compliant with guidelines, "Adherence to guidelines", and three were idiosyncratic: "Clinical picture and C-reactive protein (CRP)", "Expanded control", and "Unstructured". The residual uncertainty differed for the different strategies: in the strategy "Adherence to guidelines" and "Clinical picture and CRP" uncertainty was avoided, based either on adherence to guidelines or on the clinical picture and near-patient CRP; in the strategy "Expanded control" uncertainty was balanced based on expanded control; and in the strategy "Unstructured" uncertainty prevailed in spite of redundant examination and anamnesis. Conclusion: The majority of the GPS avoided uncertainty and deemed they had no problems. Their strategies either adhered to guidelines or comprised excessive use of tests. Thus use of guidelines as well as use of more near-patient tests seemed associated to reduced uncertainty, although the later strategy at the expense of compliance to guidelines. A few GPS did not manage to cope with uncertainty or had to put in excessive work to control uncertainty.</p>}},
author = {{Andre, Malin and Gröndal, Hedvig and Strandberg, Eva Lena and Brorsson, Annika and Hedin, Katarina}},
issn = {{1471-2296}},
keywords = {{C-reactive protein; General practitioners; Guideline; Qualitative research; Sore throat; Uncertainty}},
language = {{eng}},
month = {{05}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{BMC Family Practice}},
title = {{Uncertainty in clinical practice - An interview study with Swedish GPS on patients with sore throat}},
url = {{http://dx.doi.org/10.1186/s12875-016-0452-9}},
doi = {{10.1186/s12875-016-0452-9}},
volume = {{17}},
year = {{2016}},
}