Reasons for low usage of strep A rapid antigen detection tests for pharyngitis in private medical practice
Rapid group A Streptococcus (GAS) antigen detection tests (RDT) have high diagnostic performance for the management of acute pharyngitis and are recommended before any antibiotic (ATB) prescription in France to reduce ATB use. The rate of general practitioners (GPs) using GAS RDT is low and decreasi...
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| Veröffentlicht in: | Archives de pédiatrie : organe officiel de la Société française de pédiatrie 2013-10, Vol.20 (10), p.1083-1088 |
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| container_title | Archives de pédiatrie : organe officiel de la Société française de pédiatrie |
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| creator | Park, M Hue, V Dubos, F Lagrée, M Pruvost, I Martinot, A |
| description | Rapid group A Streptococcus (GAS) antigen detection tests (RDT) have high diagnostic performance for the management of acute pharyngitis and are recommended before any antibiotic (ATB) prescription in France to reduce ATB use. The rate of general practitioners (GPs) using GAS RDT is low and decreasing. Our aims were to describe the reasons for pediatricians and GPs not using RDT or for prescribing ATB despite of a negative RDT.
In 2011, a survey was conducted in a random sample of 368 GPs plus all ambulatory pediatricians (n=82) in the Nord-Pas-de-Calais region of France.
Response rates were 74% (n=61) for pediatricians and 18% (n=68) for GPs. RDTs for pharyngitis were used by 75% [95% CI: 63-85] of pediatricians and 53% [95% CI: 41-64] of GPs (P |
| doi_str_mv | 10.1016/j.arcped.2013.07.002 |
| format | Article |
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In 2011, a survey was conducted in a random sample of 368 GPs plus all ambulatory pediatricians (n=82) in the Nord-Pas-de-Calais region of France.
Response rates were 74% (n=61) for pediatricians and 18% (n=68) for GPs. RDTs for pharyngitis were used by 75% [95% CI: 63-85] of pediatricians and 53% [95% CI: 41-64] of GPs (P<0.001). RDTs were systematically used in children 3years of age and older by only 59% of all physicians using RDTs. An ATB was systematically prescribed in case of positive RDT by 96% of physicians and eventually prescribed in case of negative RDT by 74%. The main reasons for ATB prescription in case of negative RDT were association with otitis media (51%), second visit for the same pharyngitis (45%), and high clinical suspicion of GAS pharyngitis (36%). Forty percent of non-RDT users had used them in the past. The 3 main reasons for not using RDT were the lack of time (57%), high confidence in clinical data to discriminate GAS pharyngitis (48%), and low confidence in RDT (27%).
This survey highlights the lack of knowledge about low and high discriminant values of clinical data and RDT, respectively, especially the excellent negative predictive value of RDTs, and an erroneous assessment of the low risk of missing GAS pharyngitis compared to the consequences of inappropriate ATB use.</description><identifier>EISSN: 1769-664X</identifier><identifier>DOI: 10.1016/j.arcped.2013.07.002</identifier><identifier>PMID: 23932873</identifier><language>fre</language><publisher>France</publisher><subject>Antigens, Bacterial - analysis ; Child, Preschool ; France ; General Practitioners ; Humans ; Microbial Sensitivity Tests - utilization ; Pediatrics ; Pharyngitis - diagnosis ; Practice Patterns, Physicians' - statistics & numerical data ; Streptococcal Infections - diagnosis ; Streptococcus pyogenes - immunology ; Surveys and Questionnaires</subject><ispartof>Archives de pédiatrie : organe officiel de la Société française de pédiatrie, 2013-10, Vol.20 (10), p.1083-1088</ispartof><rights>Copyright © 2013 Elsevier Masson SAS. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27913,27914</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23932873$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Park, M</creatorcontrib><creatorcontrib>Hue, V</creatorcontrib><creatorcontrib>Dubos, F</creatorcontrib><creatorcontrib>Lagrée, M</creatorcontrib><creatorcontrib>Pruvost, I</creatorcontrib><creatorcontrib>Martinot, A</creatorcontrib><title>Reasons for low usage of strep A rapid antigen detection tests for pharyngitis in private medical practice</title><title>Archives de pédiatrie : organe officiel de la Société française de pédiatrie</title><addtitle>Arch Pediatr</addtitle><description>Rapid group A Streptococcus (GAS) antigen detection tests (RDT) have high diagnostic performance for the management of acute pharyngitis and are recommended before any antibiotic (ATB) prescription in France to reduce ATB use. The rate of general practitioners (GPs) using GAS RDT is low and decreasing. Our aims were to describe the reasons for pediatricians and GPs not using RDT or for prescribing ATB despite of a negative RDT.
In 2011, a survey was conducted in a random sample of 368 GPs plus all ambulatory pediatricians (n=82) in the Nord-Pas-de-Calais region of France.
Response rates were 74% (n=61) for pediatricians and 18% (n=68) for GPs. RDTs for pharyngitis were used by 75% [95% CI: 63-85] of pediatricians and 53% [95% CI: 41-64] of GPs (P<0.001). RDTs were systematically used in children 3years of age and older by only 59% of all physicians using RDTs. An ATB was systematically prescribed in case of positive RDT by 96% of physicians and eventually prescribed in case of negative RDT by 74%. The main reasons for ATB prescription in case of negative RDT were association with otitis media (51%), second visit for the same pharyngitis (45%), and high clinical suspicion of GAS pharyngitis (36%). Forty percent of non-RDT users had used them in the past. The 3 main reasons for not using RDT were the lack of time (57%), high confidence in clinical data to discriminate GAS pharyngitis (48%), and low confidence in RDT (27%).
This survey highlights the lack of knowledge about low and high discriminant values of clinical data and RDT, respectively, especially the excellent negative predictive value of RDTs, and an erroneous assessment of the low risk of missing GAS pharyngitis compared to the consequences of inappropriate ATB use.</description><subject>Antigens, Bacterial - analysis</subject><subject>Child, Preschool</subject><subject>France</subject><subject>General Practitioners</subject><subject>Humans</subject><subject>Microbial Sensitivity Tests - utilization</subject><subject>Pediatrics</subject><subject>Pharyngitis - diagnosis</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Streptococcal Infections - diagnosis</subject><subject>Streptococcus pyogenes - immunology</subject><subject>Surveys and Questionnaires</subject><issn>1769-664X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1kEtrwzAQhEWhNOnjH5SiYy92V5YtW8cQ-oJAoeTQm9FjlSo4smvJLf33NSQ9LQMzw7dDyC2DnAETD_tcjWZAmxfAeA51DlCckSWrhcyEKD8W5DLGPQA00PALsii45EVT8yXZv6OKfYjU9SPt-h86RbVD2jsa04gDXdFRDd5SFZLfYaAWE5rk-0ATxnSMDZ9q_A07n3ykPtBh9N8qIT2g9UZ1s1ZzwuA1OXeqi3hzuldk-_S4Xb9km7fn1_Vqkw2V4BnqxgHUDZcotDZaI0gnG6WgclUjuQYtpTZMFqbgQjuQ1jAHAoy1CkrHr8j9sXYY-69phmwPPhrsOhWwn2LLypKXTMiKz9a7k3XSM207kx_mV9r_efgf465pRw</recordid><startdate>201310</startdate><enddate>201310</enddate><creator>Park, M</creator><creator>Hue, V</creator><creator>Dubos, F</creator><creator>Lagrée, M</creator><creator>Pruvost, I</creator><creator>Martinot, A</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201310</creationdate><title>Reasons for low usage of strep A rapid antigen detection tests for pharyngitis in private medical practice</title><author>Park, M ; Hue, V ; Dubos, F ; Lagrée, M ; Pruvost, I ; Martinot, A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p563-eb8f007839e6bbcbbe09f98aa05f5893b0b99bc192c236bf09dc1f060cdda04f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>fre</language><creationdate>2013</creationdate><topic>Antigens, Bacterial - analysis</topic><topic>Child, Preschool</topic><topic>France</topic><topic>General Practitioners</topic><topic>Humans</topic><topic>Microbial Sensitivity Tests - utilization</topic><topic>Pediatrics</topic><topic>Pharyngitis - diagnosis</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Streptococcal Infections - diagnosis</topic><topic>Streptococcus pyogenes - immunology</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Park, M</creatorcontrib><creatorcontrib>Hue, V</creatorcontrib><creatorcontrib>Dubos, F</creatorcontrib><creatorcontrib>Lagrée, M</creatorcontrib><creatorcontrib>Pruvost, I</creatorcontrib><creatorcontrib>Martinot, A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Archives de pédiatrie : organe officiel de la Société française de pédiatrie</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Park, M</au><au>Hue, V</au><au>Dubos, F</au><au>Lagrée, M</au><au>Pruvost, I</au><au>Martinot, A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reasons for low usage of strep A rapid antigen detection tests for pharyngitis in private medical practice</atitle><jtitle>Archives de pédiatrie : organe officiel de la Société française de pédiatrie</jtitle><addtitle>Arch Pediatr</addtitle><date>2013-10</date><risdate>2013</risdate><volume>20</volume><issue>10</issue><spage>1083</spage><epage>1088</epage><pages>1083-1088</pages><eissn>1769-664X</eissn><abstract>Rapid group A Streptococcus (GAS) antigen detection tests (RDT) have high diagnostic performance for the management of acute pharyngitis and are recommended before any antibiotic (ATB) prescription in France to reduce ATB use. The rate of general practitioners (GPs) using GAS RDT is low and decreasing. Our aims were to describe the reasons for pediatricians and GPs not using RDT or for prescribing ATB despite of a negative RDT.
In 2011, a survey was conducted in a random sample of 368 GPs plus all ambulatory pediatricians (n=82) in the Nord-Pas-de-Calais region of France.
Response rates were 74% (n=61) for pediatricians and 18% (n=68) for GPs. RDTs for pharyngitis were used by 75% [95% CI: 63-85] of pediatricians and 53% [95% CI: 41-64] of GPs (P<0.001). RDTs were systematically used in children 3years of age and older by only 59% of all physicians using RDTs. An ATB was systematically prescribed in case of positive RDT by 96% of physicians and eventually prescribed in case of negative RDT by 74%. The main reasons for ATB prescription in case of negative RDT were association with otitis media (51%), second visit for the same pharyngitis (45%), and high clinical suspicion of GAS pharyngitis (36%). Forty percent of non-RDT users had used them in the past. The 3 main reasons for not using RDT were the lack of time (57%), high confidence in clinical data to discriminate GAS pharyngitis (48%), and low confidence in RDT (27%).
This survey highlights the lack of knowledge about low and high discriminant values of clinical data and RDT, respectively, especially the excellent negative predictive value of RDTs, and an erroneous assessment of the low risk of missing GAS pharyngitis compared to the consequences of inappropriate ATB use.</abstract><cop>France</cop><pmid>23932873</pmid><doi>10.1016/j.arcped.2013.07.002</doi><tpages>6</tpages></addata></record> |
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| source | Elsevier ScienceDirect Journals Complete - AutoHoldings; MEDLINE |
| subjects | Antigens, Bacterial - analysis Child, Preschool France General Practitioners Humans Microbial Sensitivity Tests - utilization Pediatrics Pharyngitis - diagnosis Practice Patterns, Physicians' - statistics & numerical data Streptococcal Infections - diagnosis Streptococcus pyogenes - immunology Surveys and Questionnaires |
| title | Reasons for low usage of strep A rapid antigen detection tests for pharyngitis in private medical practice |
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