scholarly journals The Effect of Amoxicillin in Adult Patients Presenting to Primary Care with Acute Cough Predicted to Have Pneumonia or a Combined Viral-Bacterial Infection

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 817
Author(s):  
Robin Bruyndonckx ◽  
Beth Stuart ◽  
Paul Little ◽  
Niel Hens ◽  
Margareta Ieven ◽  
...  
Keyword(s):  
Primary Care ◽  
Bacterial Infection ◽  
Controlled Trial ◽  
Symptom Duration ◽  
Antibiotic Prescribing ◽  
Clinical Prediction ◽  
Acute Cough ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Combined Infection

While most cases of acute cough are self-limiting, antibiotics are prescribed to over 50%. This proportion is inappropriately high given that benefit from treatment with amoxicillin could only be demonstrated in adults with pneumonia (based on chest radiograph) or combined viral–bacterial infection (based on modern microbiological methodology). As routine use of chest radiographs and microbiological testing is costly, clinical prediction rules could be used to identify these patient subsets. In this secondary analysis of data from a multicentre randomised controlled trial in adults presenting to primary care with acute cough, we used prediction rules for pneumonia or combined infection and assessed the effect of amoxicillin in patients predicted to have pneumonia or combined infection on symptom duration, symptom severity and illness deterioration. In total, 2056 patients that fulfilled all inclusion criteria were randomised, 1035 to amoxicillin, 1021 to placebo. Neither patients with a predicted pneumonia nor patients with a predicted combined infection were significantly more likely to benefit from amoxicillin. While the studied clinical prediction rules may help primary care clinicians to reduce antibiotic prescribing for low-risk patients, they did not identify adult acute cough patients that would benefit from amoxicillin treatment.

scholarly journals Developing an International Register of Clinical Prediction Rules for Use in Primary Care: A Descriptive Analysis

2014 ◽  
Vol 12 (4) ◽  
pp. 359-366 ◽  
Author(s):  
C. Keogh ◽  
E. Wallace ◽  
K. K. O'Brien ◽  
R. Galvin ◽  
S. M. Smith ◽  
...  
Keyword(s):  
Primary Care ◽  
Descriptive Analysis ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules

Optimized retrieval of primary care clinical prediction rules from MEDLINE to establish a web-based register

2011 ◽  
Vol 64 (8) ◽  
pp. 848-860 ◽  
Author(s):  
Claire Keogh ◽  
Emma Wallace ◽  
Kirsty K. O’Brien ◽  
Paul J. Murphy ◽  
Conor Teljeur ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Web Based ◽  
Prediction Rules

scholarly journals Translation of clinical prediction rules for febrile children to primary care practice: an observational cohort study

2015 ◽  
Vol 65 (633) ◽  
pp. e224-e233 ◽  
Author(s):  
Yvette van Ierland ◽  
Gijs Elshout ◽  
Marjolein Y Berger ◽  
Yvonne Vergouwe ◽  
Marcel de Wilde ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Primary Care Practice ◽  
Observational Cohort Study ◽  
Care Practice ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Observational Cohort

An Ontology-Driven Approach to Clinical Evidence Modelling Implementing Clinical Prediction Rules

2013 ◽  
pp. 257-284 ◽  
Author(s):  
Derek Corrigan ◽  
Lucy Hederman ◽  
Haseeb Khan ◽  
Adel Taweel ◽  
Olga Kostopoulou ◽  
...  
Keyword(s):  
Primary Care ◽  
Evidence Based Medicine ◽  
Clinical Evidence ◽  
Evidence Based ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Support Provision ◽  
Primary Care Clinicians ◽  
Based Medicine

Diagnostic error is a major threat to patient safety in the context of the primary care setting. Evidence-based medicine has been advocated as one part of a solution. The ability to effectively apply evidence-based medicine implies the use of information systems by providing efficient access to the latest peer-reviewed evidence-based information sources. A fundamental challenge in applying information technology to a diagnostic clinical domain is how to formally represent known clinical knowledge as part of an underlying evidence repository. Clinical prediction rules (CPRs) can provide the basis for a formal representation of knowledge. The TRANSFoRm project defines the architectural components required to deliver a solution by providing an ontology driven clinical evidence service to support provision of diagnostic tools, designed to be maintained and updated from electronic sources of research data, to assist primary care clinicians during the patient consultation through delivery of up to date evidence based diagnostic rules.

scholarly journals Understanding general practitioners’ views and experiences of using clinical prediction rules in the management of respiratory infections: a qualitative study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0096
Author(s):  
Hilda O Hounkpatin ◽  
Catherine Woods ◽  
Mark Lown ◽  
Beth Stuart ◽  
Geraldine M Leydon
Keyword(s):  
Public Involvement ◽  
Clinical Decision Making ◽  
Respiratory Infections ◽  
Clinical Decision ◽  
Routine Practice ◽  
Antibiotic Prescribing ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Tract Infections

Background:Respiratory tract infections (RTIs) account for 60% of antibiotic prescribing in primary care. Several clinical prediction rules (CPRs) have been developed to help reduce unnecessary prescribing for RTIs, but there are a lack of studies exploring whether or how these CPRs are being used in UK general practice.Aim:To explore UK GPs’ views and experiences with regards to RTI CPRs and to identify barriers and facilitators to their use in practice.Design & setting:A qualitative analysis of interviews with in-hours GPs working in the South and South West of England.Method:Semi-structured qualitative telephone interviews were conducted, digitally recorded, transcribed verbatim and analysed using an inductive thematic approach. Patient and public involvement representatives contributed to study design and interpretation of findings.Results:Thirty-two GPs were interviewed. Some CPRs were more commonly used than others. Participants used CPRs to facilitate patient-clinician discussion, confirm and support their decision, and document the consultation. GPs also highlighted concerns including lack of time, inability of CPRs to incorporate patient complexity, a shift in focus from the patient during consultations, and limited use in remote consultation (during the COVID-19 pandemic).Conclusion:This study highlights the need for user-friendly CPRs that are readily integrated into computer systems, and easily embedded into routine practice to complement clinical decision making. Existing CPRs need to be validated for other populations where demographics and clinical characteristics may differ as well different settings including remote consultations and self-assessment.

scholarly journals Real-life impact of clinical prediction rules for venous thromboembolism in primary care: a cross-sectional cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039913
Author(s):  
Rosanne van Maanen ◽  
Annelieke E C Kingma ◽  
Ruud Oudega ◽  
Frans H Rutten ◽  
Karel Moons ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Venous Thromboembolism ◽  
Failure Rate ◽  
Real Life ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Cross Sectional ◽  
Prediction Rules ◽  
Life Impact

ObjectiveClinical prediction rules (CPRs) followed by D-dimer testing were shown to safely rule out venous thromboembolism (VTE) in about half of all suspected patients in controlled and experienced study settings. Yet, its real-life impact in primary care is unknown. The aim of this study was to determine the real-life impact of CPRs for suspected VTE in primary care.DesignCross-sectional cohort study.SettingPrimary care in the Netherlands.ParticipantsPatients with suspected deep venous thrombosis (n=993) and suspected pulmonary embolism (n=484).InterventionsGeneral practitioners received an educational instruction on how to use CPRs in suspected VTE. We did not rectify incorrect application of the CPR in order to mimic daily clinical care.Main outcome measuresPrimary outcomes were the diagnostic failure rate, defined as the 3-month incidence of VTE in the non-referred group, and the efficiency, defined as the proportion of non-referred patients in the total study population. Secondary outcomes were determinants for and consequences of incorrect application of the CPRs.ResultsIn 267 of the included 1477 patients, VTE was confirmed. When CPRs were correctly applied, the failure rate was 1.51% (95% CI 0.77 to 2.86), and the efficiency was 58.1% (95% CI 55.2 to 61.0). However, the CPRs were incorrectly applied in 339 patients, which resulted in an increased failure rate of 3.31% (95% CI 1.07 to 8.76) and a decreased efficiency of 35.7% (95% CI 30.6 to 41.1). The presence of concurrent heart failure increased the likelihood of incorrect application (adjusted OR 3.26; 95% CI 1.47 to 7.21).ConclusionsCorrect application of CPRs for VTE in primary care is associated with an acceptable low failure rate at a high efficiency. Importantly, in nearly a quarter of patients, the CPRs were incorrectly applied that resulted in a higher failure rate and a considerably lower efficiency.

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