title: Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial.
abstract: OBJECTIVE
  The purpose of the study was to assess the long-term effect of family physicians' use of C-reactive protein (CRP) point-of-care testing and/or physician training in enhanced communication skills on office visit rates and antibiotic prescriptions for patients with respiratory tract infections.
  
  
  METHODS
  We conducted a 3.5-year follow-up of a pragmatic, factorial, cluster-randomized controlled trial; 379 patients (20 family practices in the Netherlands) who visited their family physician for acute cough were enrolled in the trial and had follow-up data available (88% of original trial cohort). Main outcome measures were the average number of episodes of respiratory tract infections for which patients visited their family physician per patient per year (PPPY), and the percentage of the episodes for which patients were treated with antibiotics during follow-up.
  
  
  RESULTS
  The mean number of episodes of respiratory tract infections during follow-up was 0.40 PPPY in the CRP test group and 0.56 PPPY in the no CRP test group (P = .12). In the communication skills training group, there was a mean of 0.36 PPPY episodes of respiratory tract infections, and in the no training group the mean was 0.57 PPPY (P = .09). During follow-up 30.7% of all episodes of respiratory tract infection were treated with antibiotics in the CRP test group compared with 35.7% in the no test group (P = .36). Family physicians trained in communication skills treated 26.3% of all episodes of respiratory tract infection with antibiotics compared with 39.1% treated by family physicians without training in communication skills (P = .02)
  
  
  CONCLUSIONS
  Family physicians' use of CRP point-of-care testing and/or training in enhanced communication skills did not significantly affect office visit rates related to respiratory tract infections. Patients who saw a family physician trained in enhanced communication skills were prescribed significantly fewer antibiotics during episodes of respiratory tract infection in the subsequent 3.5 years.
authors.affiliation: Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, The Netherlands. j.cals@maastrichtuniversity.nl
authors.forename: Jochen W L
authors.initials: JW
authors.lastname: Cals
authors.forename: Leon
authors.initials: L
authors.lastname: de Bock
authors.forename: Pieter-Jan H W
authors.initials: PJ
authors.lastname: Beckers
authors.forename: Nick A
authors.initials: NA
authors.lastname: Francis
authors.forename: Rogier M
authors.initials: RM
authors.lastname: Hopstaken
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.forename: Eefje G P M
authors.initials: EG
authors.lastname: de Bont
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000592:standards / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D003142:Communication; D015897:Comorbidity; D018450:Disease Progression; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010821:Physicians, Family; D019095:Point-of-Care Systems; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D012720:Severity of Illness Index; D013995:Time
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein