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Research

Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries

Alike W van der Velden, Alma C van de Pol, Emily Bongard, Daniela Cianci, Rune Aabenhus, Anca Balan, Femke Böhmer, Valerija Bralić Lang, Pascale Bruno, Slawomir Chlabicz, Samuel Coenen, Annelies Colliers, Ana García-Sangenís, Hrachuhi Ghazaryan, Maciej Godycki-Ćwirko, Siri Jensen, Christos Lionis, Sanne R van der Linde, Lile Malania, Jozsef Pauer, Angela Tomacinschii, Akke Vellinga, Ihor Zastavnyy, Susanne Emmerich, Adam Zerda, Theo J Verheij, Herman Goossens and Christopher C Butler
BJGP Open 2022; 6 (2): BJGPO.2021.0212. DOI: https://doi.org/10.3399/BJGPO.2021.0212
Alike W van der Velden
1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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  • For correspondence: a.w.vandervelden{at}umcutrecht.nl
Alma C van de Pol
1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Emily Bongard
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Daniela Cianci
1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Rune Aabenhus
3 Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Anca Balan
4 Balan Medfam SRL, Cluj Napoca, Romania
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Femke Böhmer
5 Institute of General Practice, Rostock University Medical Center, Rostock, Germany
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Valerija Bralić Lang
6 Department of Family Medicine, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
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Pascale Bruno
7 Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Nice, France
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Slawomir Chlabicz
8 Department of Family Medicine, Medical University of Bialystok, Bialystok, Poland
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Samuel Coenen
9 Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
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  • ORCID record for Samuel Coenen
Annelies Colliers
9 Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
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Ana García-Sangenís
10 Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
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Hrachuhi Ghazaryan
11 Wigmore Clinic, Yerevan, Armenia
12 Yerevan State Medical University, Yerevan, Armenia
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Maciej Godycki-Ćwirko
13 Centre for Family and Community Medicine, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland
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Siri Jensen
14 The Antibiotic Centre for Primary Care, Department of General Practice, University of Oslo, Oslo, Norway
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Christos Lionis
15 Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece
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Sanne R van der Linde
1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Lile Malania
16 National Center for Disease Control and Public Health, Tbilisi, Georgia
17 Amer Science Management LLC, Tbilisi, Georgia
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Jozsef Pauer
18 DRC Drug Research Centre, Balatonfüred, Hungary
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Angela Tomacinschii
19 University Clinic of Primary Medical Assistance, Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, The Republic of Moldova
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Akke Vellinga
20 School of Medicine, National University of Ireland, Galway, Ireland
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Ihor Zastavnyy
21 NGO Academy of Family Medicine of Ukraine, Lviv, Ukraine
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Susanne Emmerich
22 Abbott Rapid Diagnostics Germany GmbH, Cologne, Germany
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Adam Zerda
23 AMR Strategy & Development, Becton Dickinson and Co, North Carolina, NC, US
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Theo J Verheij
1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Herman Goossens
24 Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Christopher C Butler
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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    Figure 1. Country variation in point-of-care and laboratory or hospital-based diagnostic testing, and in medication prescribing for respiratory tract infection in primary care. AB = antibiotic. AH = antihistamine. AM = Armenia. AV = antiviral. BE = Belgium. DE = Germany. DK = Denmark. ES = Spain. FR = France. GE = Georgia. GR = Greece. HR = Croatia. HU = Hungary. IE = Ireland. INH = inhaled medication. LAB = laboratory or hospital-based. MD = Moldova. NL = the Netherlands. NO = Norway. O = other prescribed medication. PL = Poland. POC = point of care. UA = Ukraine. UK = United Kingdom.
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    Figure 2. Percentages of consultations by level of confidence in the antibiotic prescribing decision; A) split by suspected viral, bacterial, and unclear aetiology; and B) split by testing group. AB = antibiotic prescribed. –AB = no antibiotic prescribed. POC = point-of-care. LAB = laboratory or hospital-based. POC+LAB = point-of-care plus laboratory or hospital-based.

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    Table 1. Multivariable analysis of factors associated with antibiotic prescribing
    CategoryAll (strep A and CRP)Lower RTI (CRP)Sore throat (strep A)
    Adj OR95% CIAdj OR95% CIAdj OR95% CI
    Use of POC test(s)1.30.9 to 1.80.70.4 to 1.1 2.4 1.3 to 4.3
    Moderate illness severity 7.4 6.2 to 8.9 5.3 3.8 to 7.3 9.5 6.9 to 13.0
    Severe illness 8.0 5.4 to 12.0 4.1 2.3 to 7.2 3.6 1.2 to 11.0
    Age, year 1.02 1.01 to 1.02 1.02 1.02 to 1.03 1.01 1.00 to 1.02
    Comorbidity 1.3 1.1 to 1.5 1.10.8 to 1.51.00.6 to 1.4
    Fever 1.6 1.3 to 1.9 2.9 2.1 to 4.0 2.0 1.5 to 2.8
    Duration (day) 1.03 1.02 to 1.04 1.03 1.00 to 1.05 1.05 1.00 to 1.10
    CountryOR for 17 countries shown in Supplementary Table S3
    • Multivariable mixed-effects logistic regression for the dependent variable antibiotic prescribing controlling for country, use of group A streptococcal (strep A) and/or C-reactive protein (CRP) point-of-care (POC) testing for all patients, CRP testing for patients with lower respiratory tract infection, and strep A testing for patients with sore throat, illness severity, age, comorbidity, fever, and illness duration. Practice was included as random effect. Reference categories are Belgium (lowest antibiotic prescribing proportion) for country; ‘no’ for POC testing, comorbidity, and fever; ‘mild’ for severity; and for age and duration an increase of one unit is considered. Bold indicates significance. OR = odds ratio. RTI = respiratory tract infection.

Supplementary Data

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    Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.

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Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries
Alike W van der Velden, Alma C van de Pol, Emily Bongard, Daniela Cianci, Rune Aabenhus, Anca Balan, Femke Böhmer, Valerija Bralić Lang, Pascale Bruno, Slawomir Chlabicz, Samuel Coenen, Annelies Colliers, Ana García-Sangenís, Hrachuhi Ghazaryan, Maciej Godycki-Ćwirko, Siri Jensen, Christos Lionis, Sanne R van der Linde, Lile Malania, Jozsef Pauer, Angela Tomacinschii, Akke Vellinga, Ihor Zastavnyy, Susanne Emmerich, Adam Zerda, Theo J Verheij, Herman Goossens, Christopher C Butler
BJGP Open 2022; 6 (2): BJGPO.2021.0212. DOI: 10.3399/BJGPO.2021.0212

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Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries
Alike W van der Velden, Alma C van de Pol, Emily Bongard, Daniela Cianci, Rune Aabenhus, Anca Balan, Femke Böhmer, Valerija Bralić Lang, Pascale Bruno, Slawomir Chlabicz, Samuel Coenen, Annelies Colliers, Ana García-Sangenís, Hrachuhi Ghazaryan, Maciej Godycki-Ćwirko, Siri Jensen, Christos Lionis, Sanne R van der Linde, Lile Malania, Jozsef Pauer, Angela Tomacinschii, Akke Vellinga, Ihor Zastavnyy, Susanne Emmerich, Adam Zerda, Theo J Verheij, Herman Goossens, Christopher C Butler
BJGP Open 2022; 6 (2): BJGPO.2021.0212. DOI: 10.3399/BJGPO.2021.0212
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Keywords

  • primary health care
  • anti-bacterial agents
  • respiratory tract infections
  • diagnostics
  • C-reactive protein
  • group A streptococcus
  • GP
  • audit
  • confidence

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