1 Section of General Practice, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet2 Institute of Primary Care and Public Health. School of Medicine, Cardiff University, Cardiff, Wales firstname.lastname@example.org Department of Public Health, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet4 Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.5 University of Barcelona, Primary Care Center La Marina, Barcelona, Spain.6 University Rovira i Virgili. Primary Care Center Jaume I, Tarragona, Spain.7 unknown8 Department of Public Health, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet
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.
Respiratory Care, 2014, Vol 59, Issue 12, p. 1918-23