Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Division of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel; Clalit Health Services, Israel.
Acta Paediatr. 2013 Nov;102(11):1075-80. doi: 10.1111/apa.12364. Epub 2013 Aug 10.
To describe how physicians manage acute pharyngitis with respect to the clinical guidelines.
The computerized medical records of 105 961 children in one district of a large health maintenance organization were analysed, to identify children aged 0-18 years with a diagnosis of pharyngitis and paying their first visit for pharyngitis. Main outcome variables were whether a throat culture was performed and the time between their medical consultation and purchasing any antibiotics, if at all.
A total of 28 511 episodes of pharyngitis in 19 865 children aged 0-18, recorded by 125 physicians, were analysed (average of 1.4 episodes per child). Throat cultures were performed in 14 847 episodes (52%), with tests more common among paediatricians and younger physicians. Antibiotics were purchased in 24.8% of these cases, without knowing the result, and were more commonly associated with male physicians, family practitioners, children living in rural areas and drugs bought before the weekend.
About 50% of the physicians did not adhere to the guidelines. Factors influencing adherence included physician training, years in practice and patients' nonmedical characteristics. It is suggested that the existing clinical guidelines should address additional modifiers that will make the more applicable in practice.
描述医生在管理急性咽炎方面如何遵循临床指南。
对一个大型医疗保健组织的一个区的 105961 名儿童的计算机化病历进行了分析，以确定年龄在 0-18 岁之间、被诊断为咽炎且首次因咽炎就诊的儿童。主要观察变量为是否进行了咽拭子培养以及从就诊到购买任何抗生素（如果有）的时间。
共分析了 125 名医生记录的 19865 名儿童的 28511 次咽炎发作（平均每个儿童 1.4 次发作）。在 14847 次发作中进行了咽拭子培养（52%），儿科医生和年轻医生更常进行该检查。在这些情况下，未经检测就购买了抗生素，占 24.8%，而且更常与男性医生、家庭医生、居住在农村地区的儿童以及在周末前购买的药物相关。
约 50%的医生未遵循指南。影响遵循的因素包括医生培训、行医年限和患者的非医学特征。建议现有的临床指南应针对其他修饰符进行补充，以使指南在实践中更具适用性。
