scholarly journals Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

BMJ ◽  
2016 ◽  
pp. i3410 ◽  
Author(s):  
Martin C Gulliford ◽  
Michael V Moore ◽  
Paul Little ◽  
Alastair D Hay ◽  
Robin Fox ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Health Records ◽  
Electronic Health ◽  
Tract Infections

scholarly journals Antibiotic prescribing frequency amongst patients in primary care: a cohort study using electronic health records

2017 ◽  
Vol 72 (6) ◽  
pp. 1818-1824 ◽  
Author(s):  
Laura Shallcross ◽  
Nick Beckley ◽  
Greta Rait ◽  
Andrew Hayward ◽  
Irene Petersen
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Antibiotic Prescribing ◽  
Health Records ◽  
Electronic Health

scholarly journals Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing for Respiratory Tract Infections in Primary Care: Systematic Review and Meta-Analysis of Randomised Controlled Trials

Antibiotics ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 610
Author(s):  
Nahara Anani Martínez-González ◽  
Ellen Keizer ◽  
Andreas Plate ◽  
Samuel Coenen ◽  
Fabio Valeri ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Usual Care ◽  
Respiratory Tract Infections ◽  
Point Of Care ◽  
Antibiotic Prescribing ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Meta Analyses ◽  
Tract Infections

C-reactive protein (CRP) point-of-care testing (POCT) is increasingly being promoted to reduce diagnostic uncertainty and enhance antibiotic stewardship. In primary care, respiratory tract infections (RTIs) are the most common reason for inappropriate antibiotic prescribing, which is a major driver for antibiotic resistance. We systematically reviewed the available evidence on the impact of CRP-POCT on antibiotic prescribing for RTIs in primary care. Thirteen moderate to high-quality studies comprising 9844 participants met our inclusion criteria. Meta-analyses showed that CRP-POCT significantly reduced immediate antibiotic prescribing at the index consultation compared with usual care (RR 0.79, 95%CI 0.70 to 0.90, p = 0.0003, I2 = 76%) but not during 28-day (n = 7) follow-up. The immediate effect was sustained at 12 months (n = 1). In children, CRP-POCT reduced antibiotic prescribing when CRP (cut-off) guidance was provided (n = 2). Meta-analyses showed significantly higher rates of re-consultation within 30 days (n = 8, 1 significant). Clinical recovery, resolution of symptoms, and hospital admissions were not significantly different between CRP-POCT and usual care. CRP-POCT can reduce immediate antibiotic prescribing for RTIs in primary care (number needed to (NNT) for benefit = 8) at the expense of increased re-consultations (NNT for harm = 27). The increase in re-consultations and longer-term effects of CRP-POCT need further evaluation. Overall, the benefits of CRP-POCT outweigh the potential harms (NNTnet = 11).

scholarly journals Antibiotic exposure and ‘response failure’ for subsequent respiratory tract infections: an observational cohort study of UK preschool children in primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e638-e646 ◽  
Author(s):  
Oliver van Hecke ◽  
Alice Fuller ◽  
Clare Bankhead ◽  
Sara Jenkins-Jones ◽  
Nick Francis ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Preschool Children ◽  
Respiratory Tract ◽  
Treatment Failure ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescription ◽  
Antibiotic Exposure ◽  
Tract Infections ◽  
Antibiotic Courses

BackgroundChildhood antibiotic exposure has important clinically relevant implications. These include disruption to the microbiome, antibiotic resistance, and clinical workload manifesting as treatment ‘failure’.AimTo examine the relationship between the number of antibiotic courses prescribed to preschool children for acute respiratory tract infections (RTI), in the preceding year, and subsequent RTIs that failed to respond to antibiotic treatment (‘response failures’).Design and settingA cohort study using UK primary care data from the Clinical Practice Research Datalink, 2009 to 2016.MethodChildren aged 12 to 60 months (1 to 5 years) who were prescribed an antibiotic for an acute RTI (upper and lower RTI or otitis media) were included. One random index antibiotic course for RTI per child was selected. Exposure was the number of antibiotic prescriptions for acute RTI up to 12 months before the index antibiotic prescription. The outcome was ‘response failure’ up to 14 days after index antibiotic prescription, defined as: subsequent antibiotic prescription; referral; hospital admission; death; or emergency department attendance within 3 days. The authors used logistic regression models to estimate the odds between antibiotic exposure and response failure.ResultsOut of 114 329 children who were prescribed an antibiotic course for acute RTI, children who received ≥2 antibiotic courses for acute RTIs in the preceding year had greater odds of response failure; one antibiotic course: adjusted odds ratio (OR) 1.03 (95% confidence interval [CI] = 0.88 to 1.21), P = 0.67, n = 230 children; ≥2 antibiotic courses: adjusted OR 1.32 (CI = 1.04 to 1.66), P = 0.02, n = 97.ConclusionChildhood antibiotic exposure for acute RTI may be a good predictor for subsequent response failure (but not necessarily because of antibiotic treatment failure). Further research is needed to improve understanding of the mechanisms underlying response failure.

scholarly journals Do health checks improve risk factor detection in primary care? Matched cohort study using electronic health records

2015 ◽  
Vol 38 (3) ◽  
pp. 552-559 ◽  
Author(s):  
Alice S. Forster ◽  
Caroline Burgess ◽  
Hiten Dodhia ◽  
Frances Fuller ◽  
Jane Miller ◽  
...  
Keyword(s):  
Primary Care ◽  
Risk Factor ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Matched Cohort ◽  
Health Records ◽  
Matched Cohort Study ◽  
Health Checks ◽  
Electronic Health

scholarly journals Childhood obesity trends from primary care electronic health records in England between 1994 and 2013: population-based cohort study

2015 ◽  
Vol 100 (3) ◽  
pp. 214-219 ◽  
Author(s):  
Cornelia H M van Jaarsveld ◽  
Martin C Gulliford
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Age Groups ◽  
Overweight And Obesity ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Health Records ◽  
Obesity Trends ◽  
Electronic Health

ObjectiveThis study aimed to use primary care electronic health records to evaluate the prevalence of overweight and obesity in 2–15-year-old children in England and compare trends over the last two decades.DesignCohort study of primary care electronic health records.Setting375 general practices in England that contribute to the UK Clinical Practice Research Datalink.PatientsIndividual participants were sampled if they were aged between 2 and 15 years during the period 1994–2013 and had one or more records of body mass index (BMI).Main outcome measurePrevalence of overweight (including obesity) was defined as a BMI equal to or greater than the 85th centile of the 1990 UK reference population.ResultsData were analysed for 370 544 children with 507 483 BMI records. From 1994 to 2003, the odds of overweight and obesity increased by 8.1% per year (95% CI 7.2% to 8.9%) compared with 0.4% (−0.2% to 1.1%) from 2004 to 2013. Trends were similar for boys and girls, but differed by age groups, with prevalence stabilising in 2004 to 2013 in the younger (2–10 year) but not older (11–15 year) age group, where rates continued to increase.ConclusionsPrimary care electronic health records in England may provide a valuable resource for monitoring obesity trends. More than a third of UK children are overweight or obese, but the prevalence of overweight and obesity may have stabilised between 2004 and 2013.

scholarly journals Provider Responses to Patients Controlling Access to their Electronic Health Records: A Prospective Cohort Study in Primary Care

2014 ◽  
Vol 30 (S1) ◽  
pp. 31-37 ◽  
Author(s):  
William M. Tierney ◽  
Sheri A. Alpert ◽  
Amy Byrket ◽  
Kelly Caine ◽  
Jeremy C. Leventhal ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Health Records ◽  
Electronic Health
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