Cross-sectional survey: risk-averse French GPs use more rapid-antigen diagnostic tests in tonsillitis in children

Audrey Michel-Lepage (1) , Bruno Ventelou (2, 1) , Antoine Nebout , Pierre Verger (2) , Céline Pulcini (2, 3, 4)

1 GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille
2 SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
3 Service d'infectiologie
4 UNS - Université Nice Sophia Antipolis (1965 - 2019)

OBJECTIVES: We tested the following hypotheses: (1) risk-averse general practitioners (GPs) might use more Rapid Antigen Diagnostic Tests (RADTs) in tonsillitis in children, probably to decrease their diagnostic uncertainty regarding the aetiology of the disease (viral vs due to group A Streptococcus); and (2) GPs not using RADT might prescribe more antibiotics when they are risk averse. DESIGN, SETTING AND PARTICIPANTS: We conducted a cross-sectional survey of a nationwide French representative sample of 1093 GPs in 2012. OUTCOME MEASURES: Multivariate analyses adjusted on the four stratification variables (age, gender, location and volume of activity, ie, the number of annual consultations) were performed to identify the risk domains associated with indicators of good or poor practice. RESULTS: 69.4% of GPs were aware of national guidelines regarding tonsillitis and declared that they had taken these guidelines into account for their last paediatric tonsillitis case. 59.1% declared they used RADT in their last patient aged between 3 and 16 years presenting with tonsillitis; 29.7% of these tests were positive. Among the GPs who used RADT, 30.7% prescribed an antibiotic; 98.3% did either prescribe an antibiotic because of a positive RADT result, or did not prescribe an antibiotic in view of a negative result. Among the GPs who did not use RADT, 50.7% prescribed an antibiotic. In multivariate analyses, risk-averse GPs declared being more aware of and compliant with guidelines (OR=1.56, p\textless0.01), and used RADTs more often for their last patient (OR=1.30, p\textless0.05). Among GPs not using RADT in their last patient, risk-averse GPs prescribed more antibiotics compared with risk-tolerant doctors (OR=1.18, p\textless0.05). CONCLUSIONS: Individual risk attitudes influenced GPs' practices in tonsillitis, particularly the use of RADTs and antibiotic prescriptions.

Mots clés: Economie quantitative

Domaines: Sciences de l'Homme et Société; Economies et finances

Audrey Michel-Lepage, Bruno Ventelou, Antoine Nebout, Pierre Verger, Céline Pulcini. Cross-sectional survey: risk-averse French GPs use more rapid-antigen diagnostic tests in tonsillitis in children. BMJ Open, 2013, 3 (10), pp.e003540. ⟨10.1136/bmjopen-2013-003540⟩. ⟨hal-01500874⟩