| Autor: |
Gurudutt Naik, Rhiannon Phillips, Emma Thomas-Jones, Janine Bates, Kerenza Hood, Nick A Francis, Rachael Lowe, Hasse Melbye, Patrick White, Jochen W L Cals, Michaela Gal, Christopher C Butler, David Gillespie, Mandy Wooton, Nigel Kirby, Carl Llor, Evgenia Riga |
| Rok vydání: |
2018 |
| Předmět: |
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| Zdroj: |
General Practice and Primary Care. |
| Popis: |
Background: C-reactive protein point of care tests (CRP-POCTs) for reducing unnecessary antibiotic use without harming patients with acute exacerbations of COPD (AECOPD) in primary care have not been evaluated in randomized trials. Methods: Patients consulting at 86 general practices in England and Wales with AECOPD were randomized to undergo CRP-POCT guided management or usual management without a CRP-POCT. The co-primary outcomes were patient-reported antibiotic consumption for AECOPD within four weeks (superiority), and COPD health status measured by the Clinical COPD Questionnaire (CCQ) at two weeks (non-inferiority). Results: 653 participants were randomized. Antibiotics were consumed by 57.0% CRP-POCT and 77.4% usual care participants (adjusted odds ratio = 0.31, 95% CI: 0.20 to 0.47). Adjusted mean CCQ score difference at two-weeks was -0.19 points lower (better) for CRP-POCT participants (two-sided 90% CI: -0.33 to -0.05). CRP-POCT participants were prescribed 22% fewer antibiotics at initial consultation (47.7% vs 69.7%, AOR = 0.31, 95% CI: 0.21 to 0.45), and 21% fewer antibiotics over four-week follow-up (59.1% vs 79.7%, AOR = 0.30, 95% CI: 0.20 to 0.46). There were no meaningful between-group differences in secondary clinical, microbiological, condition specific quality of life, or service utilization outcomes. Conclusions: Primary care physician use of CRP-POCT guided management of AECOPD in primary care achieves meaningful reductions in patient reported antibiotic consumption and clinician antibiotic prescribing without a detrimental effect on patient-reported specific health status. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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