Sore throat management in New Zealand general practice

Abstract

Aim: To describe the sore throat management practices by New Zealand general practitioners (GPs) and compare the rate of sore throat presentation over time. Method: Data were collected from the National Primary Medical Care Survey carried out over 2001/2002. Analyses were done on patients who presented to the GP with the symptom of a sore throat as one of their reasons for visit. A systematic review of the New Zealand literature was done for sore throat presentation to GPs since 1966. Results: There were 10,506 records of visits gathered from 246 GPs and 335 patients presented sore throat as a reason for visit. Patients presented sore throat at a rate (SE) of 3.6 (0.26) per 100 encounters and varied by age (p=0.004), but not by socioeconomic deprivation (p=0.415) or by ethnic group (p=0.165). Patients’ perceived urgency of visit had a greater impact in the rate of presentation for the 0–4 year age group than in the at-risk age group of 5–14 years (p=0.001). GPs recorded a ‘Read code’ diagnosis at a rate of 59.2 (3.96) recordings per 100 encounters. Among the 306 recorded diagnoses, 11.4% were explicit recordings of viral diagnoses. 7.6% of GPs ranked themselves as ‘moderately’ and 2.3% as ‘highly’ uncertain of their diagnosis. Throats swabs were taken at a rate of 6.6 (1.68) swabs per 100 encounters. Antibiotic prescribing rate was higher when sore throat was recorded as a reason for visit than not (p<0.001). There were no significant differences in throat swabs taken for sore throat patients prescribed an antibiotic or not (p=0.623). No Pacific person had a throat swab taken. Patients with sore throat who were Maori (73.5 [7.2]) or Pacific people (80.2 [17.3]) were more likely to be prescribed an antibiotic than Europeans (57.4 [4.62]). Since 1966, there were 16 New Zealand studies of patients presenting with respiratory disorders to their GP. Seven of these studies measured GP management of sore throat, and only 3 of these measured the rate of patients’ sore throat symptom presentation. The rate of patients’ sore throat presentation remained similar when compared with the Waikato study of 1991 (2.8%) that had a similar methodology. Conclusion: Sore throat continues to be a common symptom that GPs manage in their work. Ethnic differences may have a part to play in how GPs manage sore throat. More research is needed to discover those factors that would encourage a greater proportion at-risk 5–14 year old children to attend their GP with sore throat.