Little, Paul, Stuart, Beth, Francis, Nick, Douglas, Elaine, Tonkin-Crine, Sarah, Anthierens, Sibyl, Cals, Jochen W., Melbye, Hasse, Santer, Miriam, Moore, Michael, Coenen, Samuel, Butler, Christopher C., Hood, Kerenza, Kelly, Mark J., Godycki-Cwirko, Maciek, Mierzecki, Artur, Torres, Antoni, Llor, Carl, Davies, Melanie J., Mullee, Mark, O'reilly, Gillian, van der Velden, Alike, Geraghty, Adam, Goossens, Herman, Verheij, Theo J. M. and Yardley, Lucy (2019) Antibiotic prescribing for acute respiratory tract infections 12 months after internet-based training in communication skills and using CRP: a multi-national randomised trial. Annals of Family Medicine, 17 (2), 125-132. (doi:10.1370/afm.2356).
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.
More information
Identifiers
Catalogue record
Export record
Altmetrics
Contributors
University divisions
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.