Why I oppose home strep testing

Yesterday I read this tweet: home strep test likely to reduce inconvenience, cost, strep complications, unneeded antibiotic and antibiotic resistance #medx I disagree, but the reasons are fairly complex. In order to understand this problem, we have to define the possible test, its use, the likely misuse and both the intended and unintended consequences of such a test. What makes a good home test?  Users should have no difficulty collecting the test sample.  The test performance must be straightforward and simple.  The test should answer a question that has a dichotomous implication. Clearly, even health care professionals receive criticism in obtaining tonsillar swabs.  So that would make our current tests difficult to perform for many at home.  Possibly one could use a spit test – again difficult to perform. One could possibly develop a test that is almost fool proof to run.  That does represent another challenge. But the real problem is the rationale for the test.  The underlying assumption of the strep test does not pass muster.  Advocates would argue that patients either have group A strep pharyngitis (and thus deserve antibiotics) or not (and thus do not deserve antibiotics).  This assumption has flaws on both positive tests and negative tests. All guidelines recommend not testing patients for group A strep unless they have a Centor score of 2 or greater.  Currently many urgent care centers, emergency departments and retail clinics test everyone, regardl...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs