Microbiological point of care testing before antibiotic prescribing in primary care: considerable variations between practices

Abstract

BackgroundPoint-of-care testing (POCT) in primary care may improve rational antibiotic prescribing. We examined use of POCT in Denmark, including patient- and general practitioner (GP)-related predictors.MethodsWe linked nationwide health care databases to assess POCT use (C-reactive protein (CRP), group A streptococcal (GAS) antigen swabs, bacteriological cultures, and urine test strips) per 1,000 overall GP consultations, 2004–2013. We computed odds ratios (OR) of POCT in patients prescribed antibiotics according to patient and GP age and sex, GP practice type, location, and workload.ResultsThe overall use of POCT in Denmark increased by 45.8% during 2004–2013, from 147.2 per 1,000 overall consultations to 214.8. CRP tests increased by 132%, bacteriological cultures by 101.7% while GAS swabs decreased by 8.6%. POCT preceded 28% of antibiotic prescriptions in 2004 increasing to 44% in 2013. The use of POCT varied more than 5-fold among individual practices, from 54.9 to 394.7 per 1,000 consultations in 2013. POCT use varied substantially with patient age, and males were less likely to receive POCT than females (adjusted OR = 0.75, 95% CI 0.74-0.75) driven by usage of urine test strips among females (18% vs. 7%). Odds of POCT were higher among female GPs and decreased with higher GP age, with lowest usage among male GPs >60 years. GP urban/rural location and workload had little impact.ConclusionGPs use POCT increasingly with the highest use among young female GPs. In 2013, 44% of all antibiotic prescriptions were preceded by POCT but testing rates vary greatly across individual GPs.

Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI

“…The use of POCT varied more than fivefold among individual practices in 2013. 32 The influence of biomarkers on antimicrobial prescribing rates in patients presenting in primary care with symptoms of RTI A 2015 survey of countries that employed CRP POCT as a diagnostic and/or prognostic tool in general practice showed those countries that used CRP POCT to some or a wide extent were: Finland, Netherlands, Denmark, Norway, Sweden, Germany, Czech Republic, Hungary, Austria, Slovenia, Latvia and Estonia. 33 34 Interestingly, these countries are the lowest 12 prescribers of antibacterials in the latest ESAC survey (figure 1).…”

Use of diagnostic tests and the appropriateness of the treatment decision in patients with suspected urinary tract infection in primary care in Denmark – observational study

“…In Denmark, suspected Urinary tract infection (UTI) is a frequent cause for antibiotic prescribing [ 4 ] and use of point-of-care tests (POCTs) [ 5 ]. There are no national guidelines on the diagnostic procedures to be followed in patients with suspected UTI.…”

The successful uptake and sustainability of rapid infectious disease and antimicrobial resistance point-of-care testing requires a complex ‘mix-and-match’ implementation package

“…This effect is not only restricted to traditional healthcare settings, but also involves potential new markets such as home-based care, telemedicine, and in-home testing and monitoring, where some form of reimbursement is essential [ 14 ]. In some countries, clinicians are funded via a national healthcare service, which may be prepared to pay for in-house medical testing, for example for PoCT performed at a general practitioner’s office [ 15 ]. However, though patient healthcare insurance may be available in some countries, not everyone can afford to pay basic healthcare insurance premiums, and a choice may have to be made between paying for a PoCT or simply buying antibiotics.…”