title: Access to point-of-care tests reduces the prescription of antibiotics among antibiotic-requesting subjects with respiratory tract infections.
abstract: BACKGROUND
  General practitioners (GPs) often feel uncomfortable when patients request an antibiotic when there is likely little benefit. This study evaluates the effect of access to point-of-care tests on decreasing the prescription of antibiotics in respiratory tract infections in subjects who explicitly requested an antibiotic prescription.
  
  
  METHODS
  Spanish GPs registered all cases of respiratory tract infections over a 3-week period before and after an intervention undertaken in 2008 and 2009. Patients with acute sinusitis, pneumonia, and exacerbations of COPD were excluded. Two types of interventions were performed: the full intervention group received prescriber feedback with discussion of the results of the first registry, courses for GPs, guidelines, patient information leaflets, workshops, and access to point-of-care tests (rapid streptococcal antigen detection test and C-reactive protein test); and the partial intervention group underwent all of the above interventions except for the workshop and access to point-of-care tests.
  
  
  RESULTS
  A total of 210 GPs were assigned to the full intervention group and 71 to the partial intervention group. A total of 25,479 subjects with respiratory tract infections were included, of whom 344 (1.4%) requested antibiotic prescribing. Antibiotics were more frequently prescribed to subjects requesting them compared with those who did not (49.1% vs 18.5%, P < .001). In the group of GPs assigned to the partial intervention group, 53.1% of subjects requesting antibiotics received a prescription before and 60% after the intervention, without statistical differences being observed. In the group of GPs assigned to the full intervention group, the percentages were 55.1% and 36.2%, respectively, with a difference of 18.9% (95% CI: 6.4%-30.6%, P < .05).
  
  
  CONCLUSIONS
  Access to point-of-care tests reduces antibiotic use in subjects who explicitly request an antibiotic prescription.
authors.affiliation: Institute of Primary Care and Public Health. School of Medicine, Cardiff University, Cardiff, Wales llorc@cardiff.ac.uk.
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.affiliation: Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Bjerrum
authors.affiliation: Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Munck
authors.affiliation: University of Barcelona, Primary Care Center La Marina, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Cots
authors.affiliation: University Rovira i Virgili. Primary Care Center Jaume I, Tarragona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Hernández
authors.affiliation: University Rovira i Virgili. Primary Care Center Jaume I, Tarragona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Moragas
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing; D005246:Feedback; D005260:Female; D058006:General Practice / Q000193:education; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D057240:Patient Preference; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D013030:Spain; D013291:Streptococcus / Q000276:immunology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D002097:C-Reactive Protein
keywords: antibiotics; audit; demand; request; respiratory tract infections