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

Respir Care. 2014 Dec;59(12):1918-23. doi: 10.4187/respcare.03275.

Abstract

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.

Keywords: antibiotics; audit; demand; request; respiratory tract infections.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 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

Substances

  • Anti-Bacterial Agents
  • Antigens, Bacterial
  • C-Reactive Protein