TY - JOUR

T1 - Point-of care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care

T2 - a prospective audit in 18 European countries

AU - van der Velden, Alike W.

AU - van de Pol, Alma C.

AU - Bongard, Emily

AU - Cianci, Daniela

AU - Aabenhus, Rune

AU - Balan, Anca

AU - Böhmer, Femke

AU - Lang, Valerija Bralić

AU - Bruno, Pascale

AU - Chlabicz, Slawomir

AU - Coenen, Samuel

AU - Colliers, Annelies

AU - García-Sangenís, Ana

AU - Ghazaryan, Hrachuhi

AU - Godycki-Ćwirko, Maciej

AU - Jensen, Siri

AU - Lionis, Christos

AU - van der Linde, Sanne R.

AU - Malania, Lile

AU - Pauer, Jozsef

AU - Tomacinschii, Angela

AU - Vellinga, Akke

AU - Zastavnyy, Ihor

AU - Emmerich, Susanne

AU - Zerda, Adam

AU - Verheij, Theo J.

AU - Goossens, Herman

AU - Butler, Christopher C.

N1 - Publisher Copyright: © This article is Open Access: CC BY license (https://creativecommons. org/licenses/by/4.0/)

PY - 2022

Y1 - 2022

N2 - Background: Between-country differences have been described in antibiotic prescribing for respiratory tract infection (RTI) in primary care, but not yet for diagnostic testing procedures and prescribing confidence. Aim: To describe between-country differences in RTI management, particularly diagnostic testing and antibiotic prescribing, and investigate which factors relate to antibiotic prescribing and GPs’ prescribing confidence. Design & setting: Prospective audit in 18 European countries. Method: An audit of GP-registered patient, clinical, and management characteristics for patients presenting with sore throat and/or lower RTI (n = 4982), and GPs' confidence in their antibiotic prescribing decision. Factors related to antibiotic prescribing and confidence were analysed using multi-level logistic regression. Results: Antibiotic prescribing proportions varied considerably: <20% in four countries, and >40% in six countries. There was also considerable variation in point-of care (POC) testing (0% in Croatia, Moldova, and Romania, and >65% in Denmark and Norway, mainly for C-reactive protein [CRP] and group A streptococcal [strep A] infection), and in laboratory or hospital-based testing (<3% in Hungary, the Netherlands, and Spain, and >30% in Croatia, Georgia, Greece, and Moldova, mainly chest X-ray and white blood cell counting). Antibiotic prescribing was related to illness severity, comorbidity, age, fever, and country, but not to having performed a POC test. In nearly 90% of consultations, GPs were confident in their antibiotic prescribing decision. Conclusion: Despite high confidence in decisions about antibiotic prescribing, there is considerable variation in the primary care of RTI in European countries, with GPs prescribing antibiotics overall more often than is considered appropriate. POC testing may enhance the quality of antibiotic prescribing decisions if it can safely reverse decisions confidently made on clinical grounds alone to prescribe

AB - Background: Between-country differences have been described in antibiotic prescribing for respiratory tract infection (RTI) in primary care, but not yet for diagnostic testing procedures and prescribing confidence. Aim: To describe between-country differences in RTI management, particularly diagnostic testing and antibiotic prescribing, and investigate which factors relate to antibiotic prescribing and GPs’ prescribing confidence. Design & setting: Prospective audit in 18 European countries. Method: An audit of GP-registered patient, clinical, and management characteristics for patients presenting with sore throat and/or lower RTI (n = 4982), and GPs' confidence in their antibiotic prescribing decision. Factors related to antibiotic prescribing and confidence were analysed using multi-level logistic regression. Results: Antibiotic prescribing proportions varied considerably: <20% in four countries, and >40% in six countries. There was also considerable variation in point-of care (POC) testing (0% in Croatia, Moldova, and Romania, and >65% in Denmark and Norway, mainly for C-reactive protein [CRP] and group A streptococcal [strep A] infection), and in laboratory or hospital-based testing (<3% in Hungary, the Netherlands, and Spain, and >30% in Croatia, Georgia, Greece, and Moldova, mainly chest X-ray and white blood cell counting). Antibiotic prescribing was related to illness severity, comorbidity, age, fever, and country, but not to having performed a POC test. In nearly 90% of consultations, GPs were confident in their antibiotic prescribing decision. Conclusion: Despite high confidence in decisions about antibiotic prescribing, there is considerable variation in the primary care of RTI in European countries, with GPs prescribing antibiotics overall more often than is considered appropriate. POC testing may enhance the quality of antibiotic prescribing decisions if it can safely reverse decisions confidently made on clinical grounds alone to prescribe

KW - Anti-bacterial agents

KW - Audit

KW - C-reactive protein

KW - Confidence

KW - Diagnostics

KW - Gp

KW - Group a streptococcus

KW - Primary health care

KW - Respiratory tract infections

U2 - 10.3399/BJGPO.2021.0212

DO - 10.3399/BJGPO.2021.0212

M3 - Journal article

C2 - 34920989

AN - SCOPUS:85129152951

VL - 6

JO - BJGP open

JF - BJGP open

SN - 2398-3795

IS - 2

M1 - BJGPO.2021.0212

ER -