Point-of care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries

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  • Alike W. van der Velden
  • Alma C. van de Pol
  • Emily Bongard
  • Daniela Cianci
  • Anca Balan
  • Femke Böhmer
  • Valerija Bralić Lang
  • Pascale Bruno
  • Slawomir Chlabicz
  • Samuel Coenen
  • Annelies Colliers
  • Ana García-Sangenís
  • Hrachuhi Ghazaryan
  • Maciej Godycki-Ćwirko
  • Siri Jensen
  • Christos Lionis
  • Sanne R. van der Linde
  • Lile Malania
  • Jozsef Pauer
  • Angela Tomacinschii
  • Akke Vellinga
  • Ihor Zastavnyy
  • Susanne Emmerich
  • Adam Zerda
  • Theo J. Verheij
  • Herman Goossens
  • Christopher C. Butler

Background: Between-country differences have been described in antibiotic prescribing for respiratory tract infection (RTI) in primary care, but not yet for diagnostic testing procedures and prescribing confidence. Aim: To describe between-country differences in RTI management, particularly diagnostic testing and antibiotic prescribing, and investigate which factors relate to antibiotic prescribing and GPs’ prescribing confidence. Design & setting: Prospective audit in 18 European countries. Method: An audit of GP-registered patient, clinical, and management characteristics for patients presenting with sore throat and/or lower RTI (n = 4982), and GPs' confidence in their antibiotic prescribing decision. Factors related to antibiotic prescribing and confidence were analysed using multi-level logistic regression. Results: Antibiotic prescribing proportions varied considerably: <20% in four countries, and >40% in six countries. There was also considerable variation in point-of care (POC) testing (0% in Croatia, Moldova, and Romania, and >65% in Denmark and Norway, mainly for C-reactive protein [CRP] and group A streptococcal [strep A] infection), and in laboratory or hospital-based testing (<3% in Hungary, the Netherlands, and Spain, and >30% in Croatia, Georgia, Greece, and Moldova, mainly chest X-ray and white blood cell counting). Antibiotic prescribing was related to illness severity, comorbidity, age, fever, and country, but not to having performed a POC test. In nearly 90% of consultations, GPs were confident in their antibiotic prescribing decision. Conclusion: Despite high confidence in decisions about antibiotic prescribing, there is considerable variation in the primary care of RTI in European countries, with GPs prescribing antibiotics overall more often than is considered appropriate. POC testing may enhance the quality of antibiotic prescribing decisions if it can safely reverse decisions confidently made on clinical grounds alone to prescribe

TidsskriftBJGP open
Udgave nummer2
Antal sider10
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
This work was supported by the Innovative Medicine Initiative 2 Joint Undertaking (grant number: 820755 [VALUE-Dx]).

Publisher Copyright:
© This article is Open Access: CC BY license (https://creativecommons. org/licenses/by/4.0/)

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