Access to point-of-care tests reduces the prescription of antibiotics among antibiotic-requesting subjects with respiratory tract infections

• Published in: Respiratory care Vol. 59; no. 12; p. 1918
• Main Authors: Llor, Carl, Bjerrum, Lars, Munck, Anders, Cots, Josep M, Hernández, Silvia, Moragas, Ana
• Format: Journal Article
• Language: English
• Published: United States 01.12.2014
• Subjects: Adolescent; Adult; Anti-Bacterial Agents - therapeutic use; Antigens, Bacterial - analysis; C-Reactive Protein - analysis; Drug Prescriptions - statistics & numerical data; Education, Medical, Continuing; Feedback; Female; General Practice - education; Humans; Male; Middle Aged; Patient Education as Topic; Patient Preference; Point-of-Care Systems; Practice Guidelines as Topic; Practice Patterns, Physicians' - statistics & numerical data; Prospective Studies; Respiratory Tract Infections - diagnosis; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - microbiology; Spain; Streptococcus - immunology; Young Adult; Spain; request; respiratory tract infections; antibiotics; demand; audit
• ISSN: 1943-3654
• DOI: 10.4187/respcare.03275

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. 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. 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). Access to point-of-care tests reduces antibiotic use in subjects who explicitly request an antibiotic prescription.