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

Author

Listed:
  • Audrey Michel-Lepage

    (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique)

  • Bruno Ventelou

    (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale, GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique)

  • Antoine Nebout
  • Pierre Verger

    (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale)

  • Céline Pulcini

    (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale, Service d'infectiologie - CHU Nice - Centre Hospitalier Universitaire de Nice - Hôpital l'Archet, UNS - Université Nice Sophia Antipolis (1965 - 2019))

Abstract

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.

Suggested Citation

  • Audrey Michel-Lepage & Bruno Ventelou & Antoine Nebout & Pierre Verger & Céline Pulcini, 2013. "Cross-sectional survey: risk-averse French GPs use more rapid-antigen diagnostic tests in tonsillitis in children," Post-Print hal-01500874, HAL.
    • Handle: RePEc:hal:journl:hal-01500874
    DOI: 10.1136/bmjopen-2013-003540
    Note: View the original document on HAL open archive server: https://amu.hal.science/hal-01500874
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    Cited by:

    1. Emmanuel Kemel & Antoine Nebout & Bruno Ventelou, 2021. "To test or not to test? Risk attitudes and prescribing by French GPs," Working Papers hal-03330153, HAL.
    2. Jacob Smith, 2023. "Considering Risk Aversion in Economic Evaluation: A Rank Dependent Approach," Papers 2311.07905, arXiv.org, revised Jan 2024.
    3. Kerstin Eilermann & Katrin Halstenberg & Ludwig Kuntz & Kyriakos Martakis & Bernhard Roth & Daniel Wiesen, 2019. "The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics: Experimental Evidence," Medical Decision Making, , vol. 39(7), pages 781-795, October.
    4. Alejandro Arrieta & Ariadna García‐Prado & Paula González & José Luis Pinto‐Prades, 2017. "Risk attitudes in medical decisions for others: An experimental approach," Health Economics, John Wiley & Sons, Ltd., vol. 26(S3), pages 97-113, December.
    5. Méndez, Susan J. & Scott, Anthony & Zhang, Yuting, 2021. "Gender differences in physician decisions to adopt new prescription drugs," Social Science & Medicine, Elsevier, vol. 277(C).
    6. Antoine Nebout & Marie Cavillon & Bruno Ventelou, 2018. "Comparing GPs’ risk attitudes for their own health and for their patients’ : a troubling discrepancy?," Post-Print hal-02084925, HAL.
    7. Eilermann, Kerstin & Halstenberg, Katrin & Kuntz, Ludwig & Martakis, Kyriakos & Roth, Bernhard & Wiesen, Daniel, 2019. "The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics: Experimental Evidence," HERO Online Working Paper Series 2020:1, University of Oslo, Health Economics Research Programme.

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    Keywords

    Economie quantitative;

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