Aix Marseille Université (Aix Marseille School of Economics-SESSTIM UMR 912, Inserm IRD), Marseille, France.
BMJ Open. 2013 Oct 25;3(10):e003540. doi: 10.1136/bmjopen-2013-003540.
We tested the following hypotheses: (1) risk-averse general practitioners (GPs) might use more Rapid Antigen Diagnostic Tests (RADTs) in tonsillitis in children, probably to decrease their diagnostic uncertainty regarding the aetiology of the disease (viral vs due to group A Streptococcus); and (2) GPs not using RADT might prescribe more antibiotics when they are risk averse.
DESIGN, SETTING AND PARTICIPANTS: We conducted a cross-sectional survey of a nationwide French representative sample of 1093 GPs in 2012.
Multivariate analyses adjusted on the four stratification variables (age, gender, location and volume of activity, ie, the number of annual consultations) were performed to identify the risk domains associated with indicators of good or poor practice.
69.4% of GPs were aware of national guidelines regarding tonsillitis and declared that they had taken these guidelines into account for their last paediatric tonsillitis case. 59.1% declared they used RADT in their last patient aged between 3 and 16 years presenting with tonsillitis; 29.7% of these tests were positive. Among the GPs who used RADT, 30.7% prescribed an antibiotic; 98.3% did either prescribe an antibiotic because of a positive RADT result, or did not prescribe an antibiotic in view of a negative result. Among the GPs who did not use RADT, 50.7% prescribed an antibiotic. In multivariate analyses, risk-averse GPs declared being more aware of and compliant with guidelines (OR=1.56, p<0.01), and used RADTs more often for their last patient (OR=1.30, p<0.05). Among GPs not using RADT in their last patient, risk-averse GPs prescribed more antibiotics compared with risk-tolerant doctors (OR=1.18, p<0.05).
Individual risk attitudes influenced GPs' practices in tonsillitis, particularly the use of RADTs and antibiotic prescriptions.
我们检验了以下假设：（1）规避风险的全科医生（GP）在儿童扁桃体炎中可能会使用更多的快速抗原诊断检测（RADT），可能是为了降低他们对疾病病因（病毒与 A 组链球菌）的诊断不确定性；（2）规避风险的 GP 不使用 RADT 时，可能会开出更多的抗生素。
设计、地点和参与者：我们于 2012 年对法国全国具有代表性的 1093 名 GP 进行了横断面调查。
对四个分层变量（年龄、性别、地点和活动量，即每年的就诊次数）进行多变量分析，以确定与良好或不良实践指标相关的风险领域。
69.4%的 GP 了解国家关于扁桃体炎的指南，并表示他们在最近的儿科扁桃体炎病例中考虑了这些指南。59.1%的 GP 声称他们在最近一位年龄在 3 至 16 岁的扁桃体炎患者中使用了 RADT；其中 29.7%的检测结果为阳性。在使用 RADT 的 GP 中，30.7%的人开了抗生素；98.3%的人因为 RADT 结果阳性而开了抗生素，或者因为结果阴性而不开抗生素。在不使用 RADT 的 GP 中，50.7%的人开了抗生素。在多变量分析中，规避风险的 GP 表示更了解和遵守指南（OR=1.56，p<0.01），并且更频繁地为最近的患者使用 RADT（OR=1.30，p<0.05）。在最近的患者中不使用 RADT 的 GP 中，规避风险的 GP 比风险容忍的医生开的抗生素更多（OR=1.18，p<0.05）。
个体风险态度影响了 GP 在扁桃体炎中的实践，特别是 RADT 的使用和抗生素的处方。
