San Andrés Health Centre, Department Preventive Medical Specialties and Public Health, University Rey Juan Carlos, Madrid, Spain.
Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Aten Primaria. 2020 Nov;52(9):637-644. doi: 10.1016/j.aprim.2020.02.016. Epub 2020 May 29.
This study was aimed at evaluating the appropriateness of use and interpretation of rapid antigen detection testing (RADT) and antibiotic prescribing for acute pharyngitis six years after a multifaceted intervention.
Before-and-after audit-based study.
Primary care centres in eight autonomous Communities.
General practitioners (GP) who had participated in the HAPPY AUDIT intervention study in 2008 and 2009 were invited to participate in a third audit-based study six years later (2015).
RADTs were provided to the participating practices and the GPs were requested to consecutively register all adults with acute pharyngitis. A registration form specifically designed for this study was used.
A total of 121 GPs out of the 210 who participated in the first two audits agreed to participate in the third audit (57.6%). They registered 3394 episodes of pharyngitis in the three registrations. RADTs were used in 51.7% of all the cases immediately after the intervention, and in 49.4% six years later. Antibiotics were prescribed in 21.3% and 36.1%, respectively (P<.001), mainly when tonsillar exudates were present, and in 5.3% and 19.2% of those with negative RADT results (P<.001). On adjustment for covariables, compared to the antibiotic prescription observed just after the intervention, significantly more antibiotics were prescribed six years later (odds ratio: 2.24, 95% confidence interval: 1.73-2.89).
This study shows that that the long-term impact of a multifaceted intervention, focusing on the use and interpretation of RADT in patients with acute pharyngitis, is reducing.
本研究旨在评估在多方面干预措施实施六年后，快速抗原检测（RADT）的使用和解释以及抗生素治疗急性咽炎的合理性。
基于前后对比的审计研究。
八个自治区的基层医疗中心。
2008 年和 2009 年参加 HAPPY AUDIT 干预研究的全科医生被邀请参加六年后（2015 年）的第三次基于审计的研究。
为参与实践提供 RADT，并要求全科医生连续登记所有急性咽炎的成年人。使用专门为此研究设计的登记表。
在最初的两次审计中，共有 210 名参与的全科医生中的 121 名同意参加第三次审计（57.6%）。他们在三次登记中记录了 3394 例咽炎发作。干预后立即使用 RADT 的病例占所有病例的 51.7%，六年后为 49.4%。分别开具抗生素的比例为 21.3%和 36.1%（P<.001），主要在扁桃体有渗出物时，而 RADT 结果阴性的病例分别为 5.3%和 19.2%（P<.001）。调整协变量后，与干预后立即开具抗生素的处方相比，六年后明显开具更多的抗生素（比值比：2.24，95%置信区间：1.73-2.89）。
本研究表明，针对急性咽炎患者使用和解释 RADT 的多方面干预措施的长期影响正在减弱。
