A pilot study of the use of near-patient C-Reactive Protein testing in the treatment of adult respiratory tract infections in one Irish general practice

Abstract

BackgroundNew approaches are being sought to safely reduce community antibiotic prescribing. A recent study demonstrated that CRP testing resulted in decreased antibiotic prescribing for lower respiratory tract infection in primary care. There is little other published primary care data available evaluating CRP in the treatment of lower respiratory tract infections in routine clinical practice. This pilot study aims to describe the performance of near-patient CRP testing, in a mixed payments health system. Specific areas to be reviewed included the integrity of the study protocol, testing of data collection forma and acceptability of the intervention.PatientsPatients over the age of 18 years, with acute cough and/or sore throat with a duration of one month or less, in routine clinical practice.MethodDesign: A pilot with a cross-sectional design. The first 60 recruited patients were treated with routine clinical management, and GP's had no access to a CRP test. For the subsequent 60 patients, access to CRP testing was available.Participants: 3 GP's in one Irish primary care practice recruited 120 patients, fulfilling the above criteria over five months, from January 1 to May 31, 2010.Main outcome measures: The primary outcome was antibiotic prescription at the index consultation. Secondary outcomes were the numbers of delayed prescriptions issued, patient satisfaction immediately after consultation and re-consultations and antibiotic prescriptions during 28 days follow-up.ResultsThe protocol and data collection forms worked well and the intervention of CRP testing appeared acceptable. Thirty-five (58%) patients in the no-test group received antibiotic prescriptions compared to 27 (45%) in the test group. Both groups demonstrated similarly high level of patient satisfaction (85%). Fourteen (23%) patients in the CRP test group re-attended within 28 days compared to 9 (15%) in the no-CRP test group.ConclusionThis pilot study confirms the potential feasibility of a full trial in Irish general practice. Further consideration of possible increased re-attendance rates in a mixed payments health system is appropriate. We intend to pursue a larger trial in a newly established regional primary care research network.

Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies

“…10,12,18,22-24 four studies got six stars, 12,18,23,24 and two studies got seven stars 10,22 (Table 1). Results of the assessment for the seven RCTs (four parallel-group RCTs and three cluster RCTs) are shown in Table 2.…”

“…[19][20][21] Six studies were observational studies. 10,12,18,[22][23][24] Table 1 summarises the basic characteristics of the included studies.…”

“…Of the 13 included studies, four studies were conducted in the Netherlands, 13,[19][20][21] three in Norway, 18,22,26 two in Denmark, 10,25 two in Spain, 12,23 one in Ireland, 24 and one in the US. 11 Four studies were parallel-group RCTs.…”

“…There were 13 studies with a total of 10 005 patients with RTIs, [10][11][12][13][18][19][20][21][22][23][24][25][26] which studied the association between POC CRP testing and antibiotic prescribing. Of the 13 included studies, four studies were conducted in the Netherlands, 13,[19][20][21] three in Norway, 18,22,26 two in Denmark, 10,25 two in Spain, 12,23 one in Ireland, 24 and one in the US.…”

“…In total 37 fulltext articles were assessed for eligibility. Of these, 13 studies were included in qualitative synthesis, [10][11][12][13][18][19][20][21][22][23][24][25][26] and subsequently all…”