Effects of C-reactive protein rapid testing and communication skills training on antibiotic prescribing for acute cough. A cluster factorial randomised controlled trial
Llor, Carl (University of Southern Denmark)
Trapero-Bertran, Marta (Universitat de Lleida)
Sisó Almirall, Antoni (Societat Catalana de Medicina Familiar i Comunitària (Barcelona, Catalunya))
Monfà, Ramon (Universitat Autònoma de Barcelona)
Abellana, Rosa (Universitat de Barcelona)
Garcia-Sangenis, Ana (Universitat Autònoma de Barcelona)
Moragas, Ana (Universitat Rovira i Virgili)
Morros, Rosa (Universitat Autònoma de Barcelona)

Data:	2024
Resum:	This cluster randomised clinical trial carried out in 20 primary care centres in Barcelona was aimed at assessing the effect of a continuous intervention focused on C-reactive protein (CRP) rapid testing and training in enhanced communication skills (ECS) on antibiotic consumption for adults with acute cough due to lower respiratory tract infection (LRTI). The interventions consisted of general practitioners and nurses' use of CRP point-of-care and training in ECS separately and combined, and usual care. The primary outcomes were antibiotic consumption and variation of the quality-adjusted life years during a 6-week follow-up. The difference in the overall antibiotic prescribing between the winter seasons before and after the intervention was calculated. The sample size calculated could not be reached due to the COVID-19 outbreak. A total of 233 patients were recruited. Compared to the usual care group (56. 7%) antibiotic consumption among patients assigned to professionals in the ECS group was significantly lower (33. 9%, adjusted odds ratio [aOR] 0. 38, 95% CI 0. 15-0. 94, p = 0. 037), whereas patients assigned to CRP consumed 43. 8% of antibiotics (aOR 0. 70, 95% CI 0. 29-1. 68, p = 0. 429) and 38. 4% in the combined intervention group (aOR 0. 45, 95% CI, 0. 17-1. 21; p = 0. 112). The overall antibiotic prescribing rates in the centres receiving training were lower after the intervention compared to those assigned to usual care, with significant reductions in β-lactam rates. Patient recovery was similar in all groups. Despite the limited power due to the low number of patients included, we observed that continuous training achieved reductions in antibiotic consumption.
Ajuts:	Fundació la Marató de TV3 201820
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Clinical trial design ; Outcomes research
Publicat a:	NPJ primary care respiratory medicine, Vol. 34 (may 2024) , ISSN 2055-1010

DOI: 10.1038/s41533-024-00368-9
PMID: 38724543

8 p, 1.2 MB

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