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. 2020 Nov;52(9):637-644.
doi: 10.1016/j.aprim.2020.02.016. Epub 2020 May 29.

Long-term impact of an intervention on rapid antigen detection tests in acute pharyngitis

José M Molero  1 , Gloria Cordoba  2 , Beatriz González López-Valcárcel  3 , Ana Moragas  4 , Juan E Losa  5 , Carles Llor  6
Affiliations

Long-term impact of an intervention on rapid antigen detection tests in acute pharyngitis

José M Molero et al. Aten Primaria. 2020 Nov.

Abstract
in English, Spanish

Objective: 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.

Design: Before-and-after audit-based study.

Location: Primary care centres in eight autonomous Communities.

Participants: 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).

Method: 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.

Results: 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).

Conclusions: 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.

Objetivo: Evaluar la adecuación del uso e interpretación de las técnicas antigénicas rápidas (TAR) y la prescripción antibiótica en la faringitis aguda 6 años después de haber realizado una intervención multifacética.

Diseño: Estudio antes-después basado en una auditoria.

Emplazamiento: Centros de salud en 8 comunidades autónomas.

Participantes: Se invitaron a médicos de familia (MF) que ya habían participado en el estudio de intervención HAPPY AUDIT en 2008 y 2009 a un nuevo AUDIT 6 años después (2015).

Método: Se proporcionaron TAR a los centros participantes, y se pidió a los MF que registraran consecutivamente a todos los adultos con faringitis aguda. Usamos un registro diseñado específicamente para este estudio.

Resultados: Ciento veintiuno MF de los 210 que participaron en los primeros registros (57,6%) aceptaron a participar en el tercer registro. Se registraron 3.394 episodios de faringitis agudas en las 3 auditorías. Se usaron TAR en el 51,7% de los casos inmediatamente después de la intervención y en el 49,4%, 6 años después. Se prescribieron antibióticos en el 21,3%y 36,1%, respectivamente (p < 0,001), principalmente cuando había exudado amigdalar y en el 5,3 y 19,2% de los resultados de TAR negativos (p < 0,001). Después de ajustar por las distintas covariables, comparado con la prescripción antibiótica observada justo después de la intervención, prescribieron significativamente más antibióticos 6 años más tarde (odds ratio: 2,24 [IC 95%: 1,73-2,89]).

Conclusiones: Este estudio muestra que se reduce el impacto de una intervención multifacética a largo plazo enfocada al uso e interpretación de TAR en pacientes con faringitis aguda.

Keywords: Agentes antibacterianos; Anti-bacterial agents; Faringitis; Intervención; Intervention; Pharyngitis; Prueba antigénica rápida; Rapid antigen detection test.

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Figures

Figure 1
Figure 1
General scheme of the study.
Figure 2
Figure 2
Antibiotic prescribing depending on the use and result of rapid antigen detection tests.
See this image and copyright information in PMC

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