Management of patients with sore throats in relation to guidelines: an interview study in Sweden
Sammanfattning
Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a
sore throat in relation to current guidelines as expressed in interviews. Design. Qualitative content
analysis was used to analyse semi-structured interviews. Setting. Swedish primary care. Subjects. A
strategic sample of 25 GPs. Main outcome measures. Perceived management of sore throat patients.
Results. It was found that nine of the interviewed GPs were adherent to current guidelines for sore
throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was
shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-
adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis
whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be
identified and treated with antibiotics. Patient history and examination was mainly targeted by
adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported
problems getting patients to abstain from antibiotics, whilst no such problems were reported in
adherent GPs. Conclusion. This interview study of sore throat management in a strategically sampled
group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to
antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs
revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care
team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by
knowledge shared in team discussions.