Evaluating a point-of-care C-reactive protein test to support antibiotic prescribing decisions in a general practice

2016 ◽  
Keyword(s):  
General Practice ◽  
Point Of Care ◽  
Antibiotic Prescribing ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals Qualitative study to explore the views of general practice staff on the use of point-of-care C reactive protein testing for the management of lower respiratory tract infections in routine general practice in England

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023925 ◽  
Author(s):  
Charlotte Victoria Eley ◽  
Anita Sharma ◽  
Donna Marie Lecky ◽  
Hazel Lee ◽  
Cliodna Ann Miriam McNulty
Keyword(s):  
General Practice ◽  
Focus Groups ◽  
Point Of Care ◽  
Easy Access ◽  
Antibiotic Prescribing ◽  
C Reactive Protein ◽  
Acute Cough ◽  
Practice Staff ◽  
Reactive Protein ◽  
Tract Infections

ObjectivesTo explore the knowledge, skills, attitudes and beliefs of general practice staff about C reactive protein (CRP) point-of-care tests (POCTs) in routine general practice and associated barriers and facilitators to implementing it to improve the management of acute cough.DesignA qualitative methodology including interviews and focus groups using the Com-B framework to understand individuals’ behaviour to implement CRP POCT in routine general practice. Data were analysed inductively and then aligned to the Com-B framework.SettingA service evaluation of CRP POCT over a 6-month period was previously conducted in randomly selected GP practices from a high prescribing National Health Service Clinicial Commissioning Groups in England. All 11 intervention practices (eight accepting CRPs; three declining CRPs) and the eight control practices, which were not offered CRP POCT, were also invited to interview. A further randomly selected practice not allocated to intervention or control was also invited to participate.ParticipantsSeven of eight accepting CRP, one of three declining CRP and four of nine control practices consented to participate. 12 practices and 26 general practice staff participated; 11 interviews, 3 focus groups and 1 hand-written response.ResultsParticipants reported that CRP POCT can increase diagnostic certainty for acute cough, inform appropriate management, manage patient expectations for antibiotics, support patient education and improve appropriate antibiotic prescribing. Reported barriers to implementing CRP POCT included: CRP cost, time, easy access to the POCT machine and effects on clinical workflow. Participants with greater CRP use usually had a dedicated staff member with the machine located in their consultation room.ConclusionsCRP POCT can help general practice staff improve patient care and education if incorporated into routine care, but this will need enthusiasts with dedicated POCT instruments or smaller, cheaper, more portable machines. In addition, funding will be needed to support test costs and staff time.

scholarly journals C-reactive protein cut-offs used for acute respiratory infections in Danish general practice

BJGP Open ◽  
2020 ◽  
pp. bjgpopen20X101136
Author(s):  
Jesper Lykkegaard ◽  
Jonas Kanstrup Olsen ◽  
Rikke Vognbjerg Sydenham ◽  
Malene Hansen
Keyword(s):  
General Practice ◽  
Respiratory Infections ◽  
Point Of Care ◽  
Signs And Symptoms ◽  
Antibiotic Prescribing ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Duration Of Symptoms ◽  
Reactive Protein ◽  
Tract Infections

Background: General practitioners (GPs) can use C-reactive protein (CRP) point-of-care test to assist when deciding whether to prescribe antibiotics for patients with acute respiratory tract infections (RTIs). Aim: To estimate which CRP cut-off levels Danish GPs use to guide antibiotic prescribing for patients presenting with different signs and symptoms of RTIs. Design and setting: Cross-sectional study. General practice in Denmark. Methods: During winter 2017 and 2018, 143 GPs and their staff registered consecutive patients with symptoms of an RTI according to the Audit Project Odense method. CRP cut-offs were estimated as the lowest level at which half of the patients were prescribed an antibiotic. Results: In total, 7,813 patients were diagnosed with an RTI of whom 4,617 (59%) had a CRP test performed. At least 25% of the patients were prescribed an antibiotic when the CRP level was above 20 mg/L, at least 50% when CRP was above 40 mg/L, and at least 75% when CRP was above 50 mg/L. Lower thresholds were identified for patients aged 65 years and those presenting with a fever, poor general appearance, dyspnoea, abnormal lung auscultation or ear/facial pain - and if the duration of symptoms was either short (≤1 day) or long (>14 days). Conclusion: More than half of patients presenting to Danish general practice with symptoms of an RTI have a CRP test performed. At CRP-levels above 40 mg/L the majority of patients have an antibiotic prescribed.

scholarly journals Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing for Respiratory Tract Infections in Primary Care: Systematic Review and Meta-Analysis of Randomised Controlled Trials

Antibiotics ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 610
Author(s):  
Nahara Anani Martínez-González ◽  
Ellen Keizer ◽  
Andreas Plate ◽  
Samuel Coenen ◽  
Fabio Valeri ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Usual Care ◽  
Respiratory Tract Infections ◽  
Point Of Care ◽  
Antibiotic Prescribing ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Meta Analyses ◽  
Tract Infections

C-reactive protein (CRP) point-of-care testing (POCT) is increasingly being promoted to reduce diagnostic uncertainty and enhance antibiotic stewardship. In primary care, respiratory tract infections (RTIs) are the most common reason for inappropriate antibiotic prescribing, which is a major driver for antibiotic resistance. We systematically reviewed the available evidence on the impact of CRP-POCT on antibiotic prescribing for RTIs in primary care. Thirteen moderate to high-quality studies comprising 9844 participants met our inclusion criteria. Meta-analyses showed that CRP-POCT significantly reduced immediate antibiotic prescribing at the index consultation compared with usual care (RR 0.79, 95%CI 0.70 to 0.90, p = 0.0003, I2 = 76%) but not during 28-day (n = 7) follow-up. The immediate effect was sustained at 12 months (n = 1). In children, CRP-POCT reduced antibiotic prescribing when CRP (cut-off) guidance was provided (n = 2). Meta-analyses showed significantly higher rates of re-consultation within 30 days (n = 8, 1 significant). Clinical recovery, resolution of symptoms, and hospital admissions were not significantly different between CRP-POCT and usual care. CRP-POCT can reduce immediate antibiotic prescribing for RTIs in primary care (number needed to (NNT) for benefit = 8) at the expense of increased re-consultations (NNT for harm = 27). The increase in re-consultations and longer-term effects of CRP-POCT need further evaluation. Overall, the benefits of CRP-POCT outweigh the potential harms (NNTnet = 11).

scholarly journals Cost-effectiveness of point-of-care C-Reactive Protein test compared to current clinical practice as an intervention to improve antibiotic prescription in malaria-negative patients in Afghanistan

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0258299
Author(s):  
Simon Dickinson ◽  
Huey Yi Chong ◽  
Toby Leslie ◽  
Mark Rowland ◽  
Kristian Schultz Hansen ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cost Effectiveness ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Healthcare Delivery ◽  
Antibiotic Prescribing ◽  
Current Clinical Practice ◽  
C Reactive Protein ◽  
Negative Patient ◽  
Reactive Protein

Background Antimicrobial resistance (AMR) is a global health problem requiring a reduction in inappropriate antibiotic prescribing. Point-of-Care C-Reactive Protein (POCCRP) tests could distinguish between bacterial and non-bacterial causes of fever in malaria-negative patients and thus reduce inappropriate antibiotic prescribing. However, the cost-effectiveness of POCCRP testing is unclear in low-income settings. Methods A decision tree model was used to estimate cost-effectiveness of POCCRP versus current clinical practice at primary healthcare facilities in Afghanistan. Data were analysed from healthcare delivery and societal perspectives. Costs were reported in 2019 USD. Effectiveness was measured as correctly treated febrile malaria-negative patient. Cost, effectiveness and diagnostic accuracy parameters were obtained from primary data from a cost-effectiveness study on malaria rapid diagnostic tests in Afghanistan and supplemented with POCCRP-specific data sourced from the literature. Incremental cost-effectiveness ratios (ICERs) reported the additional cost per additional correctly treated febrile malaria-negative patient over a 28-day time horizon. Univariate and probabilistic sensitivity analyses examined the impact of uncertainty of parameter inputs. Scenario analysis included economic cost of AMR per antibiotic prescription. Results The model predicts that POCCRP intervention would result in 137 fewer antibiotic prescriptions (6%) with a 12% reduction (279 prescriptions) in inappropriate prescriptions compared to current clinical practice. ICERs were $14.33 (healthcare delivery), $11.40 (societal), and $9.78 (scenario analysis) per additional correctly treated case. Conclusions POCCRP tests could improve antibiotic prescribing among malaria-negative patients in Afghanistan. Cost-effectiveness depends in part on willingness to pay for reductions in inappropriate antibiotic prescribing that will only have modest impact on immediate clinical outcomes but may have long-term benefits in reducing overuse of antibiotics. A reduction in the overuse of antibiotics is needed and POCCRP tests may add to other interventions in achieving this aim. Assessment of willingness to pay among policy makers and donors and undertaking operational trials will help determine cost-effectiveness and assist decision making.

scholarly journals Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial

BJGP Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. bjgpopen18X101600 ◽  
Author(s):  
Marjolein JC Schot ◽  
Ann Van den Bruel ◽  
Berna DL Broekhuizen ◽  
Jochen WL Cals ◽  
Eveline A Noteboom ◽  
...  
Keyword(s):  
General Practice ◽  
Randomised Controlled Trial ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Controlled Trial ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Randomised Controlled

BackgroundOverprescription of antibiotics for lower respiratory tract infections (LRTIs) in children is common, partly due to diagnostic uncertainty, in which case the addition of point-of-care (POC) C-reactive protein (CRP) testing can be of aid.AimTo assess whether use of POC CRP by the GP reduces antibiotic prescriptions in children with suspected non-serious LRTI.Design & settingAn open, pragmatic, randomised controlled trial in daytime general practice and out-of-hours services.MethodChildren between 3 months and 12 years of age with acute cough and fever were included and randomised to either use of POC CRP or usual care. Antibiotic prescription rates were measured and compared between groups using generalising estimating equations.ResultsThere was no statistically significant reduction in antibiotic prescriptions in the GP use of CRP group (30.9% versus 39.4%; odds ratio [OR] 0.6; 95% confidence interval [CI] = 0.29 to 1.23). Only the estimated severity of illness was related to antibiotic prescription. Forty-six per cent of children had POC CRP levels <10mg/L.ConclusionIt is still uncertain whether POC CRP measurement in children with non-serious respiratory tract infection presenting to general practice can reduce the prescription of antibiotics. Until new research provides further evidence, POC CRP measurement in these children is not recommended.

scholarly journals Prescribing antibiotics: Factors associated with C-reactive protein testing in general practice. A register-based study

2021 ◽  
Author(s):  
Rikke Vognbjerg Sydenham ◽  
Malene Plejdrup Hansen ◽  
Ulrik Stenz Justesen ◽  
Line Bjørnskov Pedersen ◽  
Rune Munck Aabenhus ◽  
...  
Keyword(s):  
General Practice ◽  
Antibiotic Prescription ◽  
Clinical Indication ◽  
Antibiotic Prescribing ◽  
Clinical Factors ◽  
C Reactive Protein ◽  
Factors Associated ◽  
Reactive Protein ◽  
Diagnostic Certainty ◽  
Tract Infections

Abstract Background The use of C-reactive protein (CRP) tests is shown to safely reduce antibiotic prescribing for acute respiratory tract infections (RTIs). The aim of this study was to explore patient and clinical factors associated with the use of CRP testing when prescribing antibiotics recommended for RTIs. Methods A nation-wide retrospective cross-sectional register-based study based on first redeemed antibiotic prescriptions issued to adults in Danish general practice between July 2015 and June 2017. Only antibiotics recommended for treatment of RTIs were included in the analysis (penicillin-V, amoxicillin, co-amoxicillin or roxithromycin/clarithromycin). Logistic regression models were used to estimate odds ratios for patient-related and clinical factors on performing a CRP test in relation to antibiotic prescribing. Results A total of 984,149 patients redeemed at least one antibiotic prescription during the two-year period. Of these, 487,939 (49.6%) were labelled with the clinical indication RTI. Patients aged 75 years and above, with a Charlson Comorbidity Index of more than one, unemployed or on disability pension, living alone, and immigrants or descendants of immigrants had lower odds of having a CRP test performed in relation to an antibiotic prescription. Being followed in practice for a chronic condition and having CRP tests performed in the previous year were associated with higher odds of CRP testing in relation to antibiotic prescribing. Conclusions Differences were observed in the use of CRP tests among subgroups of patients indicating that both sociodemographic factors and comorbidity influence the decision to use a CRP test in general practice. Potentially, this means that CRP tests are not used to an optimal extent for all groups of patients. This leaves room for improved use of CRP tests to increase diagnostic certainty and further promote rational prescribing of antibiotics.

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