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Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial

Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial
Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial
PURPOSE The purpose of the study was to assess the long-term effect of family physicians? use of C-reactive protein (CRP) point-of-care testing and/or physician training in enhanced communication skills on office visit rates and antibiotic prescriptions for patients with respiratory tract infections. METHODS We conducted a 3.5-year follow-up of a pragmatic, factorial, cluster-randomized controlled trial; 379 patients (20 family practices in the Netherlands) who visited their family physician for acute cough were enrolled in the trial and had follow-up data available (88% of original trial cohort). Main outcome measures were the average number of episodes of respiratory tract infections for which patients visited their family physician per patient per year (PPPY), and the percentage of the episodes for which patients were treated with antibiotics during follow-up. RESULTS The mean number of episodes of respiratory tract infections during follow-up was 0.40 PPPY in the CRP test group and 0.56 PPPY in the no CRP test group (P = .12). In the communication skills training group, there was a mean of 0.36 PPPY episodes of respiratory tract infections, and in the no training group the mean was 0.57 PPPY (P = .09). During follow-up 30.7% of all episodes of respiratory tract infection were treated with antibiotics in the CRP test group compared with 35.7% in the no test group (P = .36). Family physicians trained in communication skills treated 26.3% of all episodes of respiratory tract infection with antibiotics compared with 39.1% treated by family physicians without training in communication skills (P = .02). CONCLUSIONS Family physicians? use of CRP point-of-care testing and/or training in enhanced communication skills did not significantly affect office visit rates related to respiratory tract infections. Patients who saw a family physician trained in enhanced communication skills were prescribed significantly fewer antibiotics during episodes of respiratory tract infection in the subsequent 3.5 years.
respiratory tract infection, C-reactive protein, antibiotics, communication, family practice
1544-1709
157-164
Cals, J. W. L.
ec7f8605-c306-4ce0-a833-a290c963c1cf
Bock, L. de
54e45fed-bf4c-472a-baa1-2ebd72d42cf2
Beckers, P.-J. H. W.
1907359c-1ce8-4eca-9e39-4df569ee7849
Francis, N.A.
9b610883-605c-4fee-871d-defaa86ccf8e
Hopstaken, R. M.
7ee4309e-7617-496f-80a8-2731422df291
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Bont, E. G. P. M. de
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Butler, C.C.
d2f9102c-54c2-4570-be4e-32324c8c8f1d
Dinant, G.-J.
7d19eddd-8d85-4095-a68a-07e6babfb84e
Cals, J. W. L.
ec7f8605-c306-4ce0-a833-a290c963c1cf
Bock, L. de
54e45fed-bf4c-472a-baa1-2ebd72d42cf2
Beckers, P.-J. H. W.
1907359c-1ce8-4eca-9e39-4df569ee7849
Francis, N.A.
9b610883-605c-4fee-871d-defaa86ccf8e
Hopstaken, R. M.
7ee4309e-7617-496f-80a8-2731422df291
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Bont, E. G. P. M. de
5d2d1ae1-f78c-4773-8581-f374ea2a314e
Butler, C.C.
d2f9102c-54c2-4570-be4e-32324c8c8f1d
Dinant, G.-J.
7d19eddd-8d85-4095-a68a-07e6babfb84e

Cals, J. W. L., Bock, L. de, Beckers, P.-J. H. W., Francis, N.A., Hopstaken, R. M., Hood, Kerenza, Bont, E. G. P. M. de, Butler, C.C. and Dinant, G.-J. (2013) Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial. Annals of Family Medicine, 11 (2), 157-164. (doi:10.1370/afm.1477).

Record type: Article

Abstract

PURPOSE The purpose of the study was to assess the long-term effect of family physicians? use of C-reactive protein (CRP) point-of-care testing and/or physician training in enhanced communication skills on office visit rates and antibiotic prescriptions for patients with respiratory tract infections. METHODS We conducted a 3.5-year follow-up of a pragmatic, factorial, cluster-randomized controlled trial; 379 patients (20 family practices in the Netherlands) who visited their family physician for acute cough were enrolled in the trial and had follow-up data available (88% of original trial cohort). Main outcome measures were the average number of episodes of respiratory tract infections for which patients visited their family physician per patient per year (PPPY), and the percentage of the episodes for which patients were treated with antibiotics during follow-up. RESULTS The mean number of episodes of respiratory tract infections during follow-up was 0.40 PPPY in the CRP test group and 0.56 PPPY in the no CRP test group (P = .12). In the communication skills training group, there was a mean of 0.36 PPPY episodes of respiratory tract infections, and in the no training group the mean was 0.57 PPPY (P = .09). During follow-up 30.7% of all episodes of respiratory tract infection were treated with antibiotics in the CRP test group compared with 35.7% in the no test group (P = .36). Family physicians trained in communication skills treated 26.3% of all episodes of respiratory tract infection with antibiotics compared with 39.1% treated by family physicians without training in communication skills (P = .02). CONCLUSIONS Family physicians? use of CRP point-of-care testing and/or training in enhanced communication skills did not significantly affect office visit rates related to respiratory tract infections. Patients who saw a family physician trained in enhanced communication skills were prescribed significantly fewer antibiotics during episodes of respiratory tract infection in the subsequent 3.5 years.

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More information

Accepted/In Press date: 8 August 2012
Published date: 1 March 2013
Keywords: respiratory tract infection, C-reactive protein, antibiotics, communication, family practice

Identifiers

Local EPrints ID: 436299
URI: http://eprints.soton.ac.uk/id/eprint/436299
ISSN: 1544-1709
PURE UUID: 9c6414e2-6d8d-4686-9412-3a0a88cd2f63
ORCID for N.A. Francis: ORCID iD orcid.org/0000-0001-8939-7312

Catalogue record

Date deposited: 06 Dec 2019 17:30
Last modified: 09 Jan 2022 04:08

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Contributors

Author: J. W. L. Cals
Author: L. de Bock
Author: P.-J. H. W. Beckers
Author: N.A. Francis ORCID iD
Author: R. M. Hopstaken
Author: Kerenza Hood
Author: E. G. P. M. de Bont
Author: C.C. Butler
Author: G.-J. Dinant

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