scholarly journals Severity assessment for lower respiratory tract infections: potential use and validity of the CRB-65 in primary care

2011 ◽  
Vol 21 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Nick A Francis ◽  
Jochen W Cals ◽  
Christopher C Butler ◽  
Kerenza Hood ◽  
Theo Verheij ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Severity Assessment ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections ◽  
Potential Use

scholarly journals Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101015 ◽  
Author(s):  
Anna B Moberg ◽  
Olof Cronberg ◽  
Magnus Falk ◽  
Katarina Hedin
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Diagnostic Tests ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Acute Bronchitis ◽  
Antibiotic Prescribing ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections ◽  
Over Time

BackgroundDifferentiating between pneumonia and acute bronchitis is often difficult in primary care. There is no consensus regarding clinical decision rules for pneumonia, and guidelines differ between countries. Use of diagnostic tests and change of management over time is not known.AimTo calculate the proportion of diagnostic tests in the management of lower respiratory tract infections (LRTIs) in a low antibiotic prescribing country, and to evaluate if the use and prescription pattern has changed over time.Design & settingA register-based study on data from electronic health records from January 2006 to December 2014 in the Kronoberg county of south east Sweden.MethodData regarding use of C-reactive protein (CRP), chest x-rays (CXRs), microbiological tests, and antibiotic prescriptions were assessed for patients aged 18–79 years, with the diagnosis pneumonia, acute bronchitis, or cough.ResultsA total of 54 229 sickness episodes were analysed. Use of CRP increased during the study period from 61.3% to 77.5% for patients with pneumonia (P<0.001), and from 53.4% to 65.7% for patients with acute bronchitis (P<0.001). Use of CXR increased for patients with acute bronchitis from 3.1% to 5.1% (P<0.001). Use of microbiological tests increased for patients with pneumonia, from 1.8% to 5.1% (P<0.001). The antibiotic prescription rate decreased from 18.6 to 8.2 per 1000 inhabitants per year for patients with acute bronchitis, but did not change for patients with pneumonia.ConclusionUse of CRP and microbiological tests in the diagnostics of LRTIs increased despite the fact that the incidence of pneumonia and acute bronchitis was stable.

scholarly journals Qualitative interview study of parents’ perspectives, concerns and experiences of the management of lower respiratory tract infections in children in primary care

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e015701 ◽  
Author(s):  
Amy Halls ◽  
Catherine van’t Hoff ◽  
Paul Little ◽  
Theo Verheij ◽  
Geraldine M Leydon
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Symptomatic Relief ◽  
Antibiotic Use ◽  
Interview Study ◽  
Daily Routine ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

ObjectiveTo explore parents’ perspectives, concerns and experiences of the management of lower respiratory tract infections (LRTIs) in children in primary care.DesignQualitative semistructured interview study.SettingUK primary care.Participants23 parents of children aged 6 months to 10 years presenting with LRTI in primary care.MethodThematic analysis of semistructured interviews (either in person or by telephone) conducted with parents to explore their experiences and views on their children being prescribed antibiotics for LRTI.ResultsFour major themes were identified and these are perspectives on: (1) infection, (2) antibiotic use, (3) the general practitioner (GP) appointment and (4) decision making around prescribing. Symptomatic relief was a key concern: the most troublesome symptoms were cough, breathing difficulty, fever and malaise. Many parents were reluctant to use self-care medication, tended to support antibiotic use and believed they are effective for symptoms, illness duration and for preventing complications. However, parental expectations varied from a desire for reassurance and advice to an explicit preference for an antibiotic prescription. These preferences were shaped by: (1) the age of the child, with younger children perceived as more vulnerable because of their greater difficulty in communicating, and concerns about rapid deterioration; (2) the perceived severity of the illness; and (3) disruption to daily routine. When there was disagreement with the GP, parents described feeling dismissed, and they were critical of inconsistent prescribing when they reconsult. When agreement between the parent and the doctor featured, parents described a feeling of relief and legitimation for consulting, feeling reassured that the illness did indeed warrant a doctor’s attention.ConclusionSymptomatic relief is a major concern for parents. Careful exploration of expectations, and eliciting worries about key symptoms and impact on daily life will be needed to help parents understand when a no antibiotic recommendation or delayed antibiotic recommendation is made.

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