Access to Point-of-Care Tests Reduces the Prescription of Antibiotics Among Antibiotic-Requesting Subjects With Respiratory Tract Infections

TY - JOUR

T1 - Access to Point-of-Care Tests Reduces the Prescription of Antibiotics Among Antibiotic-Requesting Subjects With Respiratory Tract Infections

AU - Llor, Carl

AU - Bjerrum, Lars

AU - Munck, Anders

AU - Cots, Josep M

AU - Hernández, Silvia

AU - Moragas, Ana

AU - HAPPY AUDIT Investigators

N1 - Copyright © 2014 by Daedalus Enterprises.

PY - 2014/12

Y1 - 2014/12

N2 - BACKGROUND: General practitioners (GPs) often feel uncomfortable when patients request an antibiotic when there is likely little benefit. This study evaluates the effect of access to point-of-care tests on decreasing the prescription of antibiotics in respiratory tract infections in subjects who explicitly requested an antibiotic prescription. METHODS: Spanish GPs registered all cases of respiratory tract infections over a 3-week period before and after an intervention undertaken in 2008 and 2009. Patients with acute sinusitis, pneumonia, and exacerbations of COPD were excluded. Two types of interventions were performed: the full intervention group received prescriber feedback with discussion of the results of the first registry, courses for GPs, guidelines, patient information leaflets, workshops, and access to point-of-care tests (rapid streptococcal antigen detection test and C-reactive protein test); and the partial intervention group underwent all of the above interventions except for the workshop and access to point-of-care tests. RESULTS: A total of 210 GPs were assigned to the full intervention group and 71 to the partial intervention group. A total of 25,479 subjects with respiratory tract infections were included, of whom 344 (1.4%) requested antibiotic prescribing. Antibiotics were more frequently prescribed to subjects requesting them compared with those who did not (49.1% vs 18.5%, P < .001). In the group of GPs assigned to the partial intervention group, 53.1% of subjects requesting antibiotics received a prescription before and 60% after the intervention, without statistical differences being observed. In the group of GPs assigned to the full intervention group, the percentages were 55.1% and 36.2%, respectively, with a difference of 18.9% (95% CI: 6.4%–30.6%, P < .05). CONCLUSIONS: Access to point-of-care tests reduces antibiotic use in subjects who explicitly request an antibiotic prescription.

AB - BACKGROUND: General practitioners (GPs) often feel uncomfortable when patients request an antibiotic when there is likely little benefit. This study evaluates the effect of access to point-of-care tests on decreasing the prescription of antibiotics in respiratory tract infections in subjects who explicitly requested an antibiotic prescription. METHODS: Spanish GPs registered all cases of respiratory tract infections over a 3-week period before and after an intervention undertaken in 2008 and 2009. Patients with acute sinusitis, pneumonia, and exacerbations of COPD were excluded. Two types of interventions were performed: the full intervention group received prescriber feedback with discussion of the results of the first registry, courses for GPs, guidelines, patient information leaflets, workshops, and access to point-of-care tests (rapid streptococcal antigen detection test and C-reactive protein test); and the partial intervention group underwent all of the above interventions except for the workshop and access to point-of-care tests. RESULTS: A total of 210 GPs were assigned to the full intervention group and 71 to the partial intervention group. A total of 25,479 subjects with respiratory tract infections were included, of whom 344 (1.4%) requested antibiotic prescribing. Antibiotics were more frequently prescribed to subjects requesting them compared with those who did not (49.1% vs 18.5%, P < .001). In the group of GPs assigned to the partial intervention group, 53.1% of subjects requesting antibiotics received a prescription before and 60% after the intervention, without statistical differences being observed. In the group of GPs assigned to the full intervention group, the percentages were 55.1% and 36.2%, respectively, with a difference of 18.9% (95% CI: 6.4%–30.6%, P < .05). CONCLUSIONS: Access to point-of-care tests reduces antibiotic use in subjects who explicitly request an antibiotic prescription.

U2 - 10.4187/respcare.03275

DO - 10.4187/respcare.03275

M3 - Journal article

C2 - 25468986

SN - 0020-1324

VL - 59

SP - 1918

EP - 1923

JO - Respiratory Care

JF - Respiratory Care

IS - 12

ER -