Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
BMJ Open. 2013 Apr 3;3(4). doi: 10.1136/bmjopen-2012-002460. Print 2013.
To explore patient and healthcare professionals' (HCP) views of clinical scores and rapid streptococcal antigen detection tests (RADTs) for acute sore throat.
Qualitative semistructured interview study.
UK primary care.
General practitioners (GPs), nurse practitioners (NPs) and patients from general practices across Hampshire, Oxfordshire and the West Midlands who were participating in the Primary Care Streptococcal Management (PRISM) study.
Semistructured, face-to-face and phone interviews were conducted with GPs, NPs and patients from general practices across Hampshire, Oxfordshire and the West Midlands.
51 participants took part in the study. Of these, 42 were HCPs (29 GPs and 13 NPs) and 9 were patients. HCPs could see a positive role for RADTs in terms of reassurance, as an educational tool for patients, and for aiding inexperienced practitioners, but also had major concerns about RADT use in clinical practice. Particular concerns included the validity of the tests (the role of other bacteria, and carrier states), the tension and possible disconnect with clinical assessment and intuition, the issues of time and resource use and the potential for medicalisation of self-limiting illness. In contrast, however, experience of using RADTs over time seemed to make some participants more positive about using the tests. Moreover, patients were much more positive about the place of RADTs in providing reassurance and in limiting their antibiotic use.
It is unlikely that RADTs will have a (comfortable) place in clinical practice in the near future until health professionals' concerns are met, and they have direct experience of using them. The routine use of clinical scoring systems for acute upper respiratory illness also face important barriers related to clinicians' perceptions of their utility in the face of clinician experience and intuition.
探讨患者和医疗保健专业人员（HCP）对急性咽痛的临床评分和快速链球菌抗原检测试验（RADT）的看法。
定性半结构化访谈研究。
英国初级保健。
汉普郡、牛津郡和西米德兰兹郡的普通实践中的全科医生（GP）、执业护士（NP）和患者，他们正在参与初级保健链球菌管理（PRISM）研究。
对汉普郡、牛津郡和西米德兰兹郡的普通实践中的 GP、NP 和患者进行半结构化、面对面和电话访谈。
共有 51 名参与者参加了这项研究。其中，42 名是 HCP（29 名 GP 和 13 名 NP），9 名是患者。RADT 在以下方面可以为 HCP 提供积极的作用：为患者提供保证，作为教育工具，以及为缺乏经验的从业者提供帮助，但也对 RADT 在临床实践中的使用存在重大担忧。特别关注的问题包括测试的有效性（其他细菌和携带状态的作用）、与临床评估和直觉的紧张和可能的脱节、时间和资源使用问题以及将自限性疾病医疗化的潜在问题。然而，随着时间的推移，使用 RADT 的经验似乎使一些参与者对使用这些测试更加积极。此外，患者对 RADT 在提供保证和限制抗生素使用方面的作用更为积极。
除非满足卫生专业人员的担忧，并且他们有直接使用 RADT 的经验，否则在不久的将来，RADT 不太可能在临床实践中（舒适地）占有一席之地。急性上呼吸道感染的临床评分系统的常规使用也面临着与临床医生对其在面对临床医生经验和直觉时的实用性的看法相关的重要障碍。
