The effects of the rapid strep test on physician management of streptococcal pharyngitis.

Management of pharyngitis remains an important and controversial subject. A retrospective chart review at the University of South Alabama Family Practice Center was undertaken to assess changes in physician prescribing and testing patterns since the advent of rapid testing of streptococcal pharyngitis (rapid strep tests [RST]). Charts for study were identified by encounter form coding of a diagnosis of streptococcal pharyngitis or pharyngitis not otherwise specified. Control and test groups were formed based on the availability of the RST, and a stratified sample was drawn from each group. In the group of patients studied after the RST became available, data analysis showed a significantly increased likelihood that patients received antibiotics with a positive RST (odds ratio [OR] = 6.42), whereas those patients with a negative or no RST were significantly less likely to receive antibiotics (OR = 2.50 and 2.48, respectively). Group assignment was a significant predictor of test-ordering behavior (P less than 0.05). A higher than expected rate of streptococcal pharyngitis was noted in the group of patients who had the RST available to them. The RST plays an important though not fully defined role in the current management of pharyngitis.