Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries
Alike W van der Velden,
Alma C van de Pol,
Emily Bongard,
Daniela Cianci,
Rune Aabenhus,
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
Affiliations
Alike W van der Velden
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Alma C van de Pol
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Emily Bongard
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Daniela Cianci
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Rune Aabenhus
Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Anca Balan
Balan Medfam SRL, Cluj Napoca, Romania
Femke Böhmer
Institute of General Practice, Rostock University Medical Center, Rostock, Germany
Valerija Bralić Lang
Department of Family Medicine, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
Pascale Bruno
Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Nice, France
Slawomir Chlabicz
Department of Family Medicine, Medical University of Bialystok, Bialystok, Poland
Samuel Coenen
Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
Annelies Colliers
Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
Ana García-Sangenís
Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
Hrachuhi Ghazaryan
Wigmore Clinic, Yerevan, Armenia
Maciej Godycki-Ćwirko
Centre for Family and Community Medicine, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland
Siri Jensen
The Antibiotic Centre for Primary Care, Department of General Practice, University of Oslo, Oslo, Norway
Christos Lionis
Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece
Sanne R van der Linde
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Lile Malania
National Center for Disease Control and Public Health, Tbilisi, Georgia
Jozsef Pauer
DRC Drug Research Centre, Balatonfüred, Hungary
Angela Tomacinschii
University Clinic of Primary Medical Assistance, Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, The Republic of Moldova
Akke Vellinga
School of Medicine, National University of Ireland, Galway, Ireland
Ihor Zastavnyy
NGO Academy of Family Medicine of Ukraine, Lviv, Ukraine
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: 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 (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 antibiotics.
