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Uncertainty in clinical practice - An interview study with Swedish GPS on patients with sore throat

Andre, Malin; Gröndal, Hedvig; Strandberg, Eva Lena LU ; Brorsson, Annika LU and Hedin, Katarina LU (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.

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author
organization
publishing date
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
publisher
BioMed Central
external identifiers
  • Scopus:84969134529
  • WOS:000375989200001
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
2017-01-01 08:27:10
@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>},
  articleno    = {56},
  author       = {Andre, Malin and Gröndal, Hedvig and Strandberg, Eva Lena and Brorsson, Annika and Hedin, Katarina},
  issn         = {1471-2296},
  keyword      = {C-reactive protein,General practitioners,Guideline,Qualitative research,Sore throat,Uncertainty},
  language     = {eng},
  month        = {05},
  number       = {1},
  publisher    = {BioMed Central},
  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},
  volume       = {17},
  year         = {2016},
}