Is Scottish Intercollegiate Guidelines Network guidance for GP management of tonsillitis suitable? A qualitative study
Is Scottish Intercollegiate Guidelines Network guidance for GP management of tonsillitis suitable? A qualitative study
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DOI：
10.1093/fampra/cmy017
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发表时间：
2018-10-01
期刊：
影响因子：
2.2
通讯作者：
Haighton, Catherine A.
中科院分区：
文献类型：
--
作者：
McSweeney, Lorraine A.;Wilson, Janet A.;Haighton, Catherine A.
背景。苏格兰校际指南网络（SIGN）于1999年制定了咽喉痛的处理指南和扁桃体切除术的指征，以解决不必要手术的问题。此后，因扁桃体炎而紧急入院的人数有所增加。成人在接受扁桃体切除术前平均经历27次扁桃体炎。我们希望探讨该指南和/或其在初级保健中实施的适当性。探讨全科医生在处理成人急性扁桃体炎时对转诊标准的态度。对成人扁桃体切除术国家试验（NATTINA）可行性和过程评估的定性数据进行二次分析。参与者和设置。来自全英国的21位全科医生。与普通合伙人就NATTINA的可行性和过程评估阶段进行深入访谈。采用框架法进行分析。全科医生认为很少有必要转诊病人。他们知道指导方针，如果满足指导标准和/或缺少大量工作的患者要求，他们会转诊。该指南的引入似乎与一些人希望通过增加患者在达到转诊阈值之前必须忍受的发作次数来减少成人喉咙痛转诊和随后的扁桃体切除术的预期效果相一致。全科医生可能会发现平衡扁桃体切除术转诊具有挑战性，因为许多患者表达了强烈的手术偏好。我们相信这篇论文加强了全科医生的专业精神和以病人为中心的咨询，并挑战了临床指南的作用。
Background. The Scottish Intercollegiate Guidelines Network (SIGN) developed guidelines for the management of sore throat and indications for tonsillectomy in 1999 to address concerns of unnecessary surgery. Emergency admissions to hospital for tonsillitis have since increased. Adults experience an average of 27 episodes of tonsillitis before undergoing tonsillectomy. We wished to explore the appropriateness of the guidance and/or its implementation in primary care.Aim. To explore the attitudes of GPs to the referral criteria they use when managing adults presenting with acute tonsillitis.Design. Secondary analysis of qualitative data from the NAtional Trial of Tonsillectomy IN Adults (NATTINA) feasibility and process evaluation.Participants and Setting. Twenty-one GPs from practices throughout the UK.Method. In-depth interviews with GPs concerning both the feasibility and process evaluation phases of NATTINA. Analysis was conducted using the framework method.Results. GPs felt it was rarely necessary to refer patients. They were aware of guidelines and would refer if requested by a patient who fulfilled the guidelines criteria and/or who were missing considerable amounts of work.Conclusion. The introduction of the guidelines appears to coincide with what some may have hoped to be a desired effect of reducing adult sore throat referrals and subsequent tonsillectomies by increasing the number of episodes a patient must suffer before the referral threshold is met. GPs may find equipoise for tonsillectomy referral challenging as many patients express a strong preference for surgery. We believe this paper reinforces GP professionalism and patient-centred consultations, and challenges the role of clinical guidelines.