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Table 2 The clinical assessment, near-patient Rapid Antigen Detection Tests (RADT) and C-reactive protein (CRP)

From: Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat – a qualitative interview study

Quotation

Code

Category

Quotation A

No RADT when typical picture

Clinicalpicture makes RADT unnecessary in typical cases but used when in doubt

If they then have what’s typical for me, that they have a swollen throat with a really, you know, nasty throat, and lymph glands on the throat and just throat symptoms and fever, then I tend to think like this, yes, this is classic tonsillitis, then I don’t take any tests. (Interview 2, p. 2)

Quotation B

No RADT when decision to treat

Then I don’t send them to get Strep-A either, if I am going to treat them, unless it is of some significance. Interview 11, p. 7

Quotation C

RADT only when in doubt

But sometimes I’m uncertain, and then I take and I see that tonsillitis is… the patient has enlarged tonsils and redness, but if there’s no furring or anything, then I can take Strep-A. (Interview 22, p. 5)

Quotation D

Antibiotics when typical picture even if RADT is negative

Clinical picture dominates over negative RADT

A: Yes, yes, but even if Strep-A is negative, you sometimes give antibiotics, then?

B: Yes.

A: And what makes you give antibiotics all the same?

B: If there is clear furring … and a high temperature and clear swelling and redness even though the Strep-A is negative, then I usually check monospot too if it has been longer than five to seven days. (Interview 14, p. 9)

Quotation E

RADT does not show other bacteria

B: Yes, obviously, if the patient is affected, it can be some other streptococcus than group A, and is affected and the like, then I can prescribe treatment. Interview 19, pp. 2–3

Quotation F

There are other types of streptococcus and other types of … kinds of bacteria. Interview 11, p. 12

Quotation G

CRP indicates bacterial infection

CRP dominates over negative RADT

Then I take CRP too, to know whether it’s over fifty or sixty, then you think it’s something more bacterial than virus. (Interview 22, pp. 7–8)

B: I usually go by zero to eight, normal, eight to seventy-five indicates that you have a virus infection and seventy-five to two hundred means bacterial. (Interview 19, pp. 6–7)

Quotation H

Greater trust in CRP

 

A: But if I understand you right, if Strep-A is negative you take CRP too?

B: Exactly, yes, yes.

A: And if the CRP is high, you treat?

B: Yes. (Interview 5, pp. 6–7)