[Sore throat consultation--what is the value of a treatment guideline?]

Abstract

Objective: To investigate the possibility of rationalizing the management of sore throat in the doctor's office with the aid of appropriate guidelines.

Patients and methods: Part 1 was designed as a retrospective study involving two comparative groups: A1 under the care of general practitioner (GP) A, and B1 under the care of GP B. Part 2 was designed as a randomized prospective study involving two comparative groups and intervention: A2 under the care of GP A with no intervention, and B2 treated by GP B with intervention. The study was conducted in the group practice of the two GPs, located in a middle-sized town. Guidelines for the differential management of sore throat was developed. An overall total of 1010 patients with sore throat were divided into 4 groups, and their epidemiological data, care criteria (throat swabs, antibiotics) and effectiveness criteria (success rate, relapses) evaluated statistically using the Instat Guide program to identify guideline-influenced effects.

Results: No significant differences were to be seen between the three groups receiving routine care. In the guideline-oriented group, however, significant changes were observed (P < 0.01): more frequent identification of viral pharyngitis in comparison with other underlying clinical causes, a decrease in the frequency of throat swabs from 32% to 7%, and a decrease in the use of antibiotics from 51% to 31%, with the success and relapse rates remaining virtually unchanged.

Conclusion: The implementation of the guidelines results in the avoidance of unnecessary diagnostic measures and the overuse of antibiotics, while ensuring high-quality care and a high level of feasibility in the day-to-day work of the doctor's office.