scholarly journals Procalcitonin and lung ultrasonography point-of-care testing to decide on antibiotic prescription in patients with lower respiratory tract infection in primary care: protocol of a pragmatic cluster randomized trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Loïc Lhopitallier ◽  
Andreas Kronenberg ◽  
Jean-Yves Meuwly ◽  
Isabella Locatelli ◽  
Julie Dubois ◽  
...  
Keyword(s):  
Primary Care ◽  
Tract Infection ◽  
Lower Respiratory Tract ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Cluster Randomized Trial ◽  
Lung Ultrasonography ◽  
Point Of Care Testing ◽  
Care Protocol ◽  
Cluster Randomized

scholarly journals Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care: pragmatic cluster randomised trial

BMJ ◽  
2021 ◽  
pp. n2132
Author(s):  
Loïc Lhopitallier ◽  
Andreas Kronenberg ◽  
Jean-Yves Meuwly ◽  
Isabella Locatelli ◽  
Yolanda Mueller ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Respiratory Tract ◽  
Usual Care ◽  
General Practitioners ◽  
Lower Respiratory Tract ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Care Group ◽  
Lung Ultrasonography ◽  
Cluster Randomised

Abstract Objective To assess whether point-of care procalcitonin and lung ultrasonography can safely reduce unnecessary antibiotic treatment in patients with lower respiratory tract infections in primary care. Design Three group, pragmatic cluster randomised controlled trial from September 2018 to March 2020. Setting 60 Swiss general practices. Participants One general practitioner per practice was included. General practitioners screen all patients with acute cough; patients with clinical pneumonia were included. Interventions Randomisation in a 1:1:1 of general practitioners to either antibiotics guided by sequential procalcitonin and lung ultrasonography point-of-care tests (UltraPro; n=152), procalcitonin guided antibiotics (n=195), or usual care (n=122). Main outcomes Primary outcome was proportion of patients in each group prescribed an antibiotic by day 28. Secondary outcomes included duration of restricted activities due to lower respiratory tract infection within 14 days. Results 60 general practitioners included 469 patients (median age 53 years (interquartile range 38-66); 278 (59%) were female). Probability of antibiotic prescription at day 28 was lower in the procalcitonin group than in the usual care group (0.40 v 0.70, cluster corrected difference −0.26 (95% confidence interval −0.41 to −0.10)). No significant difference was seen between UltraPro and procalcitonin groups (0.41 v 0.40, −0.03 (−0.17 to 0.12)). The median number of days with restricted activities by day 14 was 4 days in the procalcitonin group and 3 days in the usual care group (difference 1 day (95% confidence interval −0.23 to 2.32); hazard ratio 0.75 (95% confidence interval 0.58 to 0.97)), which did not prove non-inferiority. Conclusions Compared with usual care, point-of-care procalcitonin led to a 26% absolute reduction in the probability of 28 day antibiotic prescription without affecting patients’ safety. Point-of-care lung ultrasonography did not further reduce antibiotic prescription, although a potential added value cannot be excluded, owing to the wide confidence intervals. Trial registration ClinicalTrials.gov NCT03191071 .

scholarly journals Funding and policy incentives to encourage implementation of point-of-care C-reactive protein testing for lower respiratory tract infection in NHS primary care: a mixed-methods evaluation

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e024558 ◽  
Author(s):  
Matthew Johnson ◽  
Liz Cross ◽  
Nick Sandison ◽  
Jamie Stevenson ◽  
Thomas Monks ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Lower Respiratory Tract ◽  
Point Of Care ◽  
Implementation Study ◽  
C Reactive Protein ◽  
Reactive Protein

ObjectivesUtilisation of point-of-care C-reactive protein testing for lower respiratory tract infection has been limited in UK primary care, with costs and funding suggested as important barriers. We aimed to use existing National Health Service funding and policy mechanisms to alleviate these barriers and engage with clinicians and healthcare commissioners to encourage implementation.DesignA mixed-methods study design was adopted, including a qualitative survey to identify clinicians’ and commissioners’ perceived benefits, barriers and enablers post-implementation, and quantitative analysis of results from a real-world implementation study.InterventionsWe developed a funding specification to underpin local reimbursement of general practices for test delivery based on an item of service payment. We also created training and administrative materials to facilitate implementation by reducing organisational burden. The implementation study provided intervention sites with a testing device and supplies, training and practical assistance.ResultsDespite engagement with several groups, implementation and uptake of our funding specification were limited. Survey respondents confirmed costs and funding as important barriers in addition to physical and operational constraints and cited training and the value of a local champion as enablers.ConclusionsAlthough survey respondents highlighted the clinical benefits, funding remains a barrier to implementation in UK primary care and appears not to be alleviated by the existing financial incentives available to commissioners. The potential to meet incentive targets using lower cost methods, a lack of policy consistency or competing financial pressures and commissioning programmes may be important determinants of local priorities. An implementation champion could help to catalyse support and overcome operational barriers at the local level, but widespread implementation is likely to require national policy change. Successful implementation may reproduce antibiotic prescribing reductions observed in research studies.

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