The University of Southampton
University of Southampton Institutional Repository

Antibiotic prescribing for acute respiratory tract infections 12 months after communication and CRP training: a randomized trial

Antibiotic prescribing for acute respiratory tract infections 12 months after communication and CRP training: a randomized trial
Antibiotic prescribing for acute respiratory tract infections 12 months after communication and CRP training: a randomized trial
Purpose. C-Reactive-Protein (CRP) has diagnostic utility for lower respiratory tract infections (RTI). A large international trial documented that internet-based training in communication skills, CRP point-of-care-test (POCT), or both, reduced antibiotic prescribing at 3 months (risk ratios (RR) 0.68, 0.53, 0.38, respectively). We report the longer-term impact.
Methods. 246 general practices in 6 countries were cluster-randomised to: 1) Usual care (n=61); Internet-based training for 2) CRP POCT (n=62), or 3) enhanced communication skills and interactive booklet (n=61), or 4) combined interventions (n=62). Outcome: antibiotic prescribing for RTIs audited after 12 months (12m).
Results. Of 228 practices providing 3m data, 168 (74%) provided 12m data (n=40,39,41,48, respectively) with no demonstrable attrition bias. Prescribing had reduced in usual care (3m 58% (508/870); 12m 51% (613/1194)), but increased for CRP (3m 35% (368/1062), 12m 43% (456/1052); adjusted RR compared to usual care at 12 months 0.75 (95%CI 0.51-1.00)) and combined groups (3m 32% (476/1170), 12m 45% (641/1410), RR 0.70 compared to usual care at 12 months (0.49-0.93)). Reductions for communication training were maintained (3m 41% (476/1170), 12m 40% (465/1166), RR 12m 0.70 (0.49-0.94)). Despite being freely provided, CRP POCT was hardly used at 12m, and booklets sparingly. Enhanced communication, but not CRP, remained effective for lower RTIs (RRs 0.71 (0.45-0.99), 0.76 (0.47-1.06), respectively), whereas both remained effective for upper RTIs (0.60 (0.37-0.94, 0.58 (0.36-0.92)).
Conclusion. Internet-based training in enhanced communication skills remains effective in the longer-term. The effect of CRP training wanes and becomes ineffective for LRTI, the only current indication for using CRP.
1544-1709
125-132
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Douglas, Elaine
4454f806-22da-4040-8cfe-4d6efd377ad5
Tonkin-Crine, Sarah
05504246-3ebd-46d8-bf5d-e6846d1ad675
Anthierens, Sibyl
0022fa80-cacc-4326-bf4f-4b626445626f
Cals, Jochen W.L.
ec7f8605-c306-4ce0-a833-a290c963c1cf
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Butler, Chris C.
95583b3d-b015-42de-ba2d-10de4ba67707
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Kelson, Mark
48c4cea8-67d9-4d3b-ad3f-2f917a2220e3
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Mierzecki, Artur
6453e1f8-a7cb-434b-b2f5-b11229670b70
Torres, Antoni
c505b4da-00c7-46ed-9296-985d9c120350
Llor, Carl
a7fcfced-28f4-4771-8ca5-2c1ce2095d61
Davies, Melanie
91311518-466b-4561-b27f-2ab479904e06
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
O'Reilly, Gilly
868e5b8d-ab96-4486-9c7a-9dda5a5950cc
van der Velden, Alike
1877ef56-44fb-42c9-9251-e3c7d1badb8b
Geraghty, Adam W.A.
2c6549fe-9868-4806-b65a-21881c1930af
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Douglas, Elaine
4454f806-22da-4040-8cfe-4d6efd377ad5
Tonkin-Crine, Sarah
05504246-3ebd-46d8-bf5d-e6846d1ad675
Anthierens, Sibyl
0022fa80-cacc-4326-bf4f-4b626445626f
Cals, Jochen W.L.
ec7f8605-c306-4ce0-a833-a290c963c1cf
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Butler, Chris C.
95583b3d-b015-42de-ba2d-10de4ba67707
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Kelson, Mark
48c4cea8-67d9-4d3b-ad3f-2f917a2220e3
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Mierzecki, Artur
6453e1f8-a7cb-434b-b2f5-b11229670b70
Torres, Antoni
c505b4da-00c7-46ed-9296-985d9c120350
Llor, Carl
a7fcfced-28f4-4771-8ca5-2c1ce2095d61
Davies, Melanie
91311518-466b-4561-b27f-2ab479904e06
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
O'Reilly, Gilly
868e5b8d-ab96-4486-9c7a-9dda5a5950cc
van der Velden, Alike
1877ef56-44fb-42c9-9251-e3c7d1badb8b
Geraghty, Adam W.A.
2c6549fe-9868-4806-b65a-21881c1930af
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e

Little, Paul, Stuart, Beth, Francis, Nick, Douglas, Elaine, Tonkin-Crine, Sarah, Anthierens, Sibyl, Cals, Jochen W.L., Melbye, Hasse, Santer, Miriam, Moore, Michael, Coenen, Samuel, Butler, Chris C., Hood, Kerenza, Kelson, Mark, Godycki-Cwirko, Maciek, Mierzecki, Artur, Torres, Antoni, Llor, Carl, Davies, Melanie, Mullee, Mark, O'Reilly, Gilly, van der Velden, Alike, Geraghty, Adam W.A., Goossens, Herman, Verheij, Theo and Yardley, Lucy (2019) Antibiotic prescribing for acute respiratory tract infections 12 months after communication and CRP training: a randomized trial. Annals of Family Medicine, 17 (2), 125-132. (doi:10.1370/afm.2356).

Record type: Article

Abstract

Purpose. C-Reactive-Protein (CRP) has diagnostic utility for lower respiratory tract infections (RTI). A large international trial documented that internet-based training in communication skills, CRP point-of-care-test (POCT), or both, reduced antibiotic prescribing at 3 months (risk ratios (RR) 0.68, 0.53, 0.38, respectively). We report the longer-term impact.
Methods. 246 general practices in 6 countries were cluster-randomised to: 1) Usual care (n=61); Internet-based training for 2) CRP POCT (n=62), or 3) enhanced communication skills and interactive booklet (n=61), or 4) combined interventions (n=62). Outcome: antibiotic prescribing for RTIs audited after 12 months (12m).
Results. Of 228 practices providing 3m data, 168 (74%) provided 12m data (n=40,39,41,48, respectively) with no demonstrable attrition bias. Prescribing had reduced in usual care (3m 58% (508/870); 12m 51% (613/1194)), but increased for CRP (3m 35% (368/1062), 12m 43% (456/1052); adjusted RR compared to usual care at 12 months 0.75 (95%CI 0.51-1.00)) and combined groups (3m 32% (476/1170), 12m 45% (641/1410), RR 0.70 compared to usual care at 12 months (0.49-0.93)). Reductions for communication training were maintained (3m 41% (476/1170), 12m 40% (465/1166), RR 12m 0.70 (0.49-0.94)). Despite being freely provided, CRP POCT was hardly used at 12m, and booklets sparingly. Enhanced communication, but not CRP, remained effective for lower RTIs (RRs 0.71 (0.45-0.99), 0.76 (0.47-1.06), respectively), whereas both remained effective for upper RTIs (0.60 (0.37-0.94, 0.58 (0.36-0.92)).
Conclusion. Internet-based training in enhanced communication skills remains effective in the longer-term. The effect of CRP training wanes and becomes ineffective for LRTI, the only current indication for using CRP.

Text
GRACEINTROAnnalsrevised2accepted - Accepted Manuscript
Restricted to Repository staff only
Request a copy

More information

Accepted/In Press date: 31 December 2018
e-pub ahead of print date: 1 March 2019
Published date: 1 March 2019

Identifiers

Local EPrints ID: 429611
URI: http://eprints.soton.ac.uk/id/eprint/429611
ISSN: 1544-1709
PURE UUID: f0aa19cf-eb45-4fc9-8122-9c07d91b9995
ORCID for Paul Little: ORCID iD orcid.org/0000-0003-3664-1873
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312
ORCID for Miriam Santer: ORCID iD orcid.org/0000-0001-7264-5260
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Adam W.A. Geraghty: ORCID iD orcid.org/0000-0001-7984-8351
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 01 Apr 2019 16:30
Last modified: 12 Jul 2024 02:05

Export record

Altmetrics

Contributors

Author: Paul Little ORCID iD
Author: Beth Stuart ORCID iD
Author: Nick Francis ORCID iD
Author: Elaine Douglas
Author: Sarah Tonkin-Crine
Author: Sibyl Anthierens
Author: Jochen W.L. Cals
Author: Hasse Melbye
Author: Miriam Santer ORCID iD
Author: Michael Moore ORCID iD
Author: Samuel Coenen
Author: Chris C. Butler
Author: Kerenza Hood
Author: Mark Kelson
Author: Maciek Godycki-Cwirko
Author: Artur Mierzecki
Author: Antoni Torres
Author: Carl Llor
Author: Melanie Davies
Author: Mark Mullee
Author: Gilly O'Reilly
Author: Alike van der Velden
Author: Herman Goossens
Author: Theo Verheij
Author: Lucy Yardley ORCID iD

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×