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The Impact of Point-of-Care Blood C-Reactive Protein Testing on Prescribing Antibiotics in Out-of-Hours Primary Care: A Mixed Methods Evaluation

Improving prescribing antibiotics appropriately for respiratory infections in primary care is an antimicrobial stewardship priority. There is limited evidence to support interventions to reduce prescribing antibiotics in out-of-hours (OOH) primary care. Herein, we report a service innovation where p...

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Autores principales: Dixon, Sharon, Fanshawe, Thomas R., Mwandigha, Lazaro, Edwards, George, Turner, Philip J., Glogowska, Margaret, Gillespie, Marjorie M., Blair, Duncan, Hayward, Gail N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9332095/
https://www.ncbi.nlm.nih.gov/pubmed/35892398
http://dx.doi.org/10.3390/antibiotics11081008
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author Dixon, Sharon
Fanshawe, Thomas R.
Mwandigha, Lazaro
Edwards, George
Turner, Philip J.
Glogowska, Margaret
Gillespie, Marjorie M.
Blair, Duncan
Hayward, Gail N.
author_facet Dixon, Sharon
Fanshawe, Thomas R.
Mwandigha, Lazaro
Edwards, George
Turner, Philip J.
Glogowska, Margaret
Gillespie, Marjorie M.
Blair, Duncan
Hayward, Gail N.
author_sort Dixon, Sharon
collection PubMed
description Improving prescribing antibiotics appropriately for respiratory infections in primary care is an antimicrobial stewardship priority. There is limited evidence to support interventions to reduce prescribing antibiotics in out-of-hours (OOH) primary care. Herein, we report a service innovation where point-of-care C-Reactive Protein (CRP) machines were introduced to three out-of-hours primary care clinical bases in England from August 2018–December 2019, which were compared with four control bases that did not have point-of-care CRP testing. We undertook a mixed-method evaluation, including a comparative interrupted time series analysis to compare monthly antibiotic prescription rates between bases with CRP machines and those without, an analysis of the number of and reasons for the tests performed, and qualitative interviews with clinicians. Antibiotic prescription rates declined during follow-up, but with no clear difference between the two groups of out-of-hours practices. A single base contributed 217 of the 248 CRP tests performed. Clinicians reported that the tests supported decision making and communication about not prescribing antibiotics, where having ‘objective’ numbers were helpful in navigating non-prescribing decisions and highlighted the challenges of training a fluctuant staff group and practical concerns about using the CRP machine. Service improvements to reduce prescribing antibiotics in out-of-hours primary care need to be developed with an understanding of the needs and context of this service.
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spelling pubmed-93320952022-07-29 The Impact of Point-of-Care Blood C-Reactive Protein Testing on Prescribing Antibiotics in Out-of-Hours Primary Care: A Mixed Methods Evaluation Dixon, Sharon Fanshawe, Thomas R. Mwandigha, Lazaro Edwards, George Turner, Philip J. Glogowska, Margaret Gillespie, Marjorie M. Blair, Duncan Hayward, Gail N. Antibiotics (Basel) Article Improving prescribing antibiotics appropriately for respiratory infections in primary care is an antimicrobial stewardship priority. There is limited evidence to support interventions to reduce prescribing antibiotics in out-of-hours (OOH) primary care. Herein, we report a service innovation where point-of-care C-Reactive Protein (CRP) machines were introduced to three out-of-hours primary care clinical bases in England from August 2018–December 2019, which were compared with four control bases that did not have point-of-care CRP testing. We undertook a mixed-method evaluation, including a comparative interrupted time series analysis to compare monthly antibiotic prescription rates between bases with CRP machines and those without, an analysis of the number of and reasons for the tests performed, and qualitative interviews with clinicians. Antibiotic prescription rates declined during follow-up, but with no clear difference between the two groups of out-of-hours practices. A single base contributed 217 of the 248 CRP tests performed. Clinicians reported that the tests supported decision making and communication about not prescribing antibiotics, where having ‘objective’ numbers were helpful in navigating non-prescribing decisions and highlighted the challenges of training a fluctuant staff group and practical concerns about using the CRP machine. Service improvements to reduce prescribing antibiotics in out-of-hours primary care need to be developed with an understanding of the needs and context of this service. MDPI 2022-07-26 /pmc/articles/PMC9332095/ /pubmed/35892398 http://dx.doi.org/10.3390/antibiotics11081008 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Dixon, Sharon
Fanshawe, Thomas R.
Mwandigha, Lazaro
Edwards, George
Turner, Philip J.
Glogowska, Margaret
Gillespie, Marjorie M.
Blair, Duncan
Hayward, Gail N.
The Impact of Point-of-Care Blood C-Reactive Protein Testing on Prescribing Antibiotics in Out-of-Hours Primary Care: A Mixed Methods Evaluation
title The Impact of Point-of-Care Blood C-Reactive Protein Testing on Prescribing Antibiotics in Out-of-Hours Primary Care: A Mixed Methods Evaluation
title_full The Impact of Point-of-Care Blood C-Reactive Protein Testing on Prescribing Antibiotics in Out-of-Hours Primary Care: A Mixed Methods Evaluation
title_fullStr The Impact of Point-of-Care Blood C-Reactive Protein Testing on Prescribing Antibiotics in Out-of-Hours Primary Care: A Mixed Methods Evaluation
title_full_unstemmed The Impact of Point-of-Care Blood C-Reactive Protein Testing on Prescribing Antibiotics in Out-of-Hours Primary Care: A Mixed Methods Evaluation
title_short The Impact of Point-of-Care Blood C-Reactive Protein Testing on Prescribing Antibiotics in Out-of-Hours Primary Care: A Mixed Methods Evaluation
title_sort impact of point-of-care blood c-reactive protein testing on prescribing antibiotics in out-of-hours primary care: a mixed methods evaluation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9332095/
https://www.ncbi.nlm.nih.gov/pubmed/35892398
http://dx.doi.org/10.3390/antibiotics11081008
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