scholarly journals Public perceptions about non-traditional primary care consultations, back-up prescriptions and point-of-care testing in respiratory tract infections

2019 ◽  
Vol 3 (3) ◽  
pp. 25
Author(s):  
Alexander Nicholas Moore ◽  
Nick Francis ◽  
Rebecca Cannings-John
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Point Of Care ◽  
Public Perceptions ◽  
Point Of Care Testing ◽  
Tract Infections

scholarly journals Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI

2020 ◽  
Vol 7 (1) ◽  
pp. e000624
Author(s):  
Jonathan Cooke ◽  
Carl Llor ◽  
Rogier Hopstaken ◽  
Matthew Dryden ◽  
Christopher Butler
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Point Of Care ◽  
Narrative Review ◽  
Economic Evaluations ◽  
Point Of Care Testing ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Tract Infections

Antimicrobial resistance (AMR) continues to be a global problem and continues to be addressed through national strategies to improve diagnostics, develop new antimicrobials and promote antimicrobial stewardship. Patients who attend general (ambulatory) practice with symptoms of respiratory tract infections (RTIs) are invariably assessed by some sort of clinical decision rule (CDR). However, CDRs rely on a cluster of non-specific clinical observations. A narrative review of the literature was undertaken to ascertain the value of C reactive protein (CRP) point-of-care testing (POCT) to guide antibacterial prescribing in adult patients presenting to general practitioner (GP) practices with symptoms of RTI. Studies that were included were Cochrane reviews, systematic reviews, randomised controlled trials, cluster randomised trials, controlled before and after studies, cohort studies and economic evaluations. An overwhelming number of studies demonstrated that the use of CRP tests in patients presenting with RTI symptoms reduces index antibacterial prescribing. GPs and patients report a good acceptability for a CRP POCT and economic evaluations show cost-effectiveness of CRP POCT over existing RTI management in primary care. POCTs increase diagnostic precision for GPs in the better management of patients with RTI. With the rapid development of artificial intelligence, patients will expect greater precision in diagnosing and managing their illnesses. Adopting systems that markedly reduce antibiotic consumption is a no-brainer for governments that are struggling to address the rise in AMR.

scholarly journals Current problems associated with the microbiological point-of-care testing of respiratory tract infections in primary care

2016 ◽  
Vol 11 (5) ◽  
pp. 607-610 ◽  
Author(s):  
Wendy E Kaman ◽  
Gijs Elshout ◽  
Patrick JE Bindels ◽  
Konstantinos Mitsakakis ◽  
John P Hays
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Tract Infections

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 Rapid and Point-of-Care Testing in Respiratory Tract Infections: An Antibiotic Guardian?

2020 ◽  
Vol 3 (3) ◽  
pp. 401-417 ◽  
Author(s):  
Zaneeta Dhesi ◽  
Virve I. Enne ◽  
Justin O‘Grady ◽  
Vanya Gant ◽  
David M. Livermore
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Tract Infections

scholarly journals Multiplex Tests for Respiratory Tract Infections: The Direct Utility of the FilmArray Respiratory Panel in Emergency Department

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Siyuan Yang ◽  
Hui Li ◽  
Yunxia Tang ◽  
Fengting Yu ◽  
Chengjie Ma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Tract ◽  
Influenza A ◽  
Respiratory Tract Infections ◽  
Pathogen Detection ◽  
Point Of Care ◽  
Respiratory Pathogens ◽  
Point Of Care Testing ◽  
Tract Infections ◽  
First Time

Background. The FilmArray Respiratory Panel with multiplex targets for respiratory pathogens has been widely used and verified in clinical trials in special test settings. However, it is necessary to evaluate the panel’s performance at the point of care directly, in nonspecific test settings. Methods. Patients with respiratory tract infections were enrolled from among emergency department visitors, and all steps, including the collection of specimens and testing, were performed by our clinicians. Results. Among 270 patients, 196 (72.6%) patients were found to have one or more pathogens. For signal pathogen detection, influenza A virus had the highest rate of detection; 45 (16.7%) of the patients had two or more respiratory pathogens codetected, and most of the multiplex pathogens were rhinovirus/enterovirus codetected with Bordetella pertussis (17.8%). The information provided by the FilmArray had an impact on the prescription of antimicrobials, and there were differences in the rates of antibiotic prescriptions and anti-influenza prescriptions among patients. Conclusions. Use of the FilmArray by clinical staff was successfully implemented in the emergency department for the first time in China. The FilmArray has the potential for point-of-care testing in nonspecific settings.

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