| Summary: | Sore throat is a major presenting complaint to family doctors, and while Group A Strep is a relatively rare cause with even rarer complications of rheumatic fever, antibiotics are frequently prescribed to low-risk individuals, contributing to medicalization of the sore throat, antibiotic side effects, cost to the patient, and antibiotic resistant organisms. Low-risk sore throat patients are identifiable by a clinical practice rule with validated sensitivity, specificity, and efficacy demonstrated in multiple family practice clinics in Ontario, Canada. Whether the clinical prediction rule would reduce antibiotic prescription rates in our Prince George office was studied. Antibiotic prescription rates and culture results seven before and eleven weeks after the institution of an entry space in the electronic medical record (EMR) for the result of the McIsaac clinical prediction rule (CPR) for sore throats were compared. Clinicians were familiarized with the McIsaac rule and its derivation study, and of the chart entry space for the recording of the rule score. Scoring reminders were placed in physician offices and exam rooms. Individual patient management decisions were left up to the physicians. In the seven week lead-in phase, 18 patients presented with sore throats, 12 cultures were obtained with 2 positive Group A strep results (16.6%), and antibiotics were prescribed 5 times (27% of visits). The study phase was extended to 11 weeks because of paucity of sore throat presentations, and there were 4 included sore throat presentations, and 3 (75%) cultures were all negative. No antibiotics were prescribed. Study numbers were insufficient for statistically significant comparisons. Of the significant limitations of this study, the greatest was paucity of data. The results do not allow an estimation of whether the MacIsaac CPR reduces the rate of antibiotic prescriptions for sore throats. The difficulties experienced in this study, and data from a recent randomized controlled trial in Newfoundland, cast doubt on the ...
|
|---|