RT Journal Article
SR Electronic
T1 Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP BJGPO.2021.0212
DO 10.3399/BJGPO.2021.0212
VO 6
IS 2
A1 Alike W van der Velden
A1 Alma C van de Pol
A1 Emily Bongard
A1 Daniela Cianci
A1 Rune Aabenhus
A1 Anca Balan
A1 Femke Böhmer
A1 Valerija Bralić Lang
A1 Pascale Bruno
A1 Slawomir Chlabicz
A1 Samuel Coenen
A1 Annelies Colliers
A1 Ana García-Sangenís
A1 Hrachuhi Ghazaryan
A1 Maciej Godycki-Ćwirko
A1 Siri Jensen
A1 Christos Lionis
A1 Sanne R van der Linde
A1 Lile Malania
A1 Jozsef Pauer
A1 Angela Tomacinschii
A1 Akke Vellinga
A1 Ihor Zastavnyy
A1 Susanne Emmerich
A1 Adam Zerda
A1 Theo J Verheij
A1 Herman Goossens
A1 Christopher C Butler
YR 2022
UL http://bjgpopen.org/content/6/2/BJGPO.2021.0212.abstract
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 antibiotics.