Point-of-care C-reactive protein testing to optimise antibiotic use in a primary care urgent care centre setting

Ward, Caroline

doi:10.1136/bmjoq-2018-000391

Cited by 21 publications

(23 citation statements)

References 2 publications

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“…Few interventions addressed limiting prescribing following telephone consultation and undertaking point of care tests (POCT), such as CRP. Given the potential for POCT to reduce inappropriate prescribing [67] related behaviors should be considered in the design or refinement of future interventions. Pharmacy interventions were aimed at provision of self-care advice, sharing written resources and checking antibiotic prescriptions comply with local guidance and querying those that do not.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of prescriber interventions encouraged ‘prescribing only when there is a clear clinical benefit’, ‘giving alternative self-care advice’, ‘providing a back-up prescription where appropriate’, and ‘following local antibiotic formularies.’ Few interventions addressed limiting prescribing following telephone consultation and undertaking point of care tests (POCT), such as CRP. Given the potential for POCT to reduce inappropriate prescribing [ 67 ] related behaviors should be considered in the design or refinement of future interventions. Pharmacy interventions were aimed at provision of self-care advice, sharing written resources and checking antibiotic prescriptions comply with local guidance and querying those that do not.…”

Section: Discussionmentioning

confidence: 99%

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Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

et al. 2020

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A major modifiable factor contributing to antimicrobial resistance (AMR) is inappropriate use and overuse of antimicrobials, such as antibiotics. This study aimed to describe the content and mechanism of action of antimicrobial stewardship (AMS) interventions to improve appropriate antibiotic use for respiratory tract infections (RTI) in primary and community care. This study also aimed to describe who these interventions were aimed at and the specific behaviors targeted for change. Evidence-based guidelines, peer-review publications, and infection experts were consulted to identify behaviors relevant to AMS for RTI in primary care and interventions to target these behaviors. Behavior change tools were used to describe the content of interventions. Theoretical frameworks were used to describe mechanisms of action. A total of 32 behaviors targeting six different groups were identified (patients; prescribers; community pharmacists; providers; commissioners; providers and commissioners). Thirty-nine interventions targeting the behaviors were identified (patients = 15, prescribers = 22, community pharmacy staff = 8, providers = 18, and commissioners = 18). Interventions targeted a mean of 5.8 behaviors (range 1–27). Influences on behavior most frequently targeted by interventions were psychological capability (knowledge and skills); reflective motivation (beliefs about consequences, intentions, social/professional role and identity); and physical opportunity (environmental context and resources). Interventions were most commonly characterized as achieving change by training, enabling, or educating and were delivered mainly through guidelines, service provision, and communications & marketing. Interventions included a mean of four Behavior Change Techniques (BCTs) (range 1–14). We identified little intervention content targeting automatic motivation and social opportunity influences on behavior. The majority of interventions focussed on education and training, which target knowledge and skills though the provision of instructions on how to perform a behavior and information about health consequences. Interventions could be refined with the inclusion of relevant BCTs, such as goal-setting and action planning (identified in only a few interventions), to translate instruction on how to perform a behavior into action. This study provides a platform to refine content and plan evaluation of antimicrobial stewardship interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

et al. 2020

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“…In primary care, the implementation of point-of-care testing (POCT) of C-reactive protein (CRP) and traning to improve communication skills among general practitioners were effective to optimize antibiotic use use [38]. Recently, in the United Kindom, POCT effectiveness was proved by observing a shift in the prescription pattern among general practitioners to less prescribing of antibiotics [39].…”

Section: Discussionmentioning

confidence: 99%

Seasonality of antimicrobial resistance rates in respiratory bacteria: A systematic review and meta-analysis

et al. 2019

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Background Antimicrobial resistance (AMR) rates may display seasonal variation. However, it is not clear whether this seasonality is influenced by the seasonal variation of infectious diseases, geographical region or differences in antibiotic prescription patterns. Therefore, we assessed the seasonality of AMR rates in respiratory bacteria. Methods Seven electronic databases ( Embase.com , Medline Ovid, Cochrane CENTRAL, Web of Science, Core Collection, Biosis Ovid, and Google Scholar), were searched for relevant studies from inception to Jun 25 th , 2019. Studies describing resistance rates of Streptococcus pneumoniae and Haemophilus influenzae were included in this review. By using random-effects meta-analysis, pooled odd ratios of seasonal AMR rates were calculated using winter as the reference group. Pooled odd ratios were obtained by antibiotic class and geographical region. Results We included 13 studies, of which 7 were meta-analyzed. Few studies were done in H . influenzae , thus this was not quantitively analyzed. AMR rates of S . pneumoniae to penicillins were lower in other seasons than in winter with pooled OR = 0.71; 95% CI = 0.65–0.77; I 2 = 0.0%, and to all antibiotics with pooled OR = 0.68; 95% CI = 0.60–0.76; I 2 = 14.4%. Irrespective of geographical region, the seasonality of AMR rates in S . pneumoniae remained the same. Conclusion The seasonality of AMR rates could result from the seasonality of infectious diseases and its accompanied antibiotic use.

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“…Thirteen were (cluster) randomised controlled trials, 49 52–57 61–66 two were pre–post studies, 51 58 and two were service evaluations without control groups. 59 60 Fifteen were conducted in general practice, one in an urgent care centre (evaluating C reactive protein point-of-care testing (CRP POCT)), 60 and one in a community pharmacy (evaluating sore throat test-and-treat service). 59 The update search in June 2020 identified 336 references, with none matching the inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

Optimising antimicrobial stewardship interventions in English primary care: a behavioural analysis of qualitative and intervention studies

et al. 2020

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ObjectiveWhile various interventions have helped reduce antibiotic prescribing, further gains can be made. This study aimed to identify ways to optimise antimicrobial stewardship (AMS) interventions by assessing the extent to which important influences on antibiotic prescribing are addressed (or not) by behavioural content of AMS interventions.SettingsEnglish primary care.InterventionsAMS interventions targeting healthcare professionals’ antibiotic prescribing for respiratory tract infections.MethodsWe conducted two rapid reviews. The first included qualitative studies with healthcare professionals on self-reported influences on antibiotic prescribing. The influences were inductively coded and categorised using the Theoretical Domains Framework (TDF). Prespecified criteria were used to identify key TDF domains. The second review included studies of AMS interventions. Data on effectiveness were extracted. Components of effective interventions were extracted and coded using the TDF, Behaviour Change Wheel and Behaviour Change Techniques (BCTs) taxonomy. Using prespecified matrices, we assessed the extent to which BCTs and intervention functions addressed the key TDF domains of influences on prescribing.ResultsWe identified 13 qualitative studies, 41 types of influences on antibiotic prescribing and 6 key TDF domains of influences: ‘beliefs about consequences’, ‘social influences’, ‘skills’, ‘environmental context and resources’, ‘intentions’ and ‘emotions’. We identified 17 research-tested AMS interventions; nine of them effective and four nationally implemented. Interventions addressed all six key TDF domains of influences. Four of these six key TDF domains were addressed by 50%–67% BCTs that were theoretically congruent with these domains, whereas TDF domain'skills' was addressed by 24% of congruent BCTs and 'emotions' by none.ConclusionsFurther improvement of antibiotic prescribing could be facilitated by: (1) national implementation of effective research-tested AMS interventions (eg, electronic decision support tools, training in interactive use of leaflets, point-of-care testing); (2) targeting important, less-addressed TDF domains (eg,'skills', 'emotions'); (3) using relevant, under-used BCTs to target key TDF domains (eg, ‘forming/reversing habits’, ‘reducing negative emotions’, ‘social support’). These could be incorporated into existing, or developed as new, AMS interventions.

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Point-of-care C-reactive protein testing to optimise antibiotic use in a primary care urgent care centre setting

Cited by 21 publications

References 2 publications

Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

Seasonality of antimicrobial resistance rates in respiratory bacteria: A systematic review and meta-analysis

Optimising antimicrobial stewardship interventions in English primary care: a behavioural analysis of qualitative and intervention studies

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