title: Out-of-hours antibiotic prescription after screening with C reactive protein: a randomised controlled study.
abstract: To evaluate the effect of preconsultation C reactive protein (CRP) screening on antibiotic prescribing and referral to hospital in Norwegian primary care settings with low prevalence of serious infections.
  
  
  
  Randomised controlled observational study at out-of-hours services in Norway.
  
  
  
  Primary care.
  
  
  
  401 children (0-6 years) with fever and/or respiratory symptoms were recruited from 5 different out-of-hours services (including 1 paediatric emergency clinic) in 2013-2015.
  
  
  
  Data were collected from questionnaires and clinical examination results. Every third child was randomised to a CRP test before the consultation; for the rest, the doctor ordered a CRP test if considered necessary.
  
  
  
  Main outcome variables were prescription of antibiotics and referral to hospital.
  
  
  
  In the group pretested with CRP, the antibiotic prescription rate was 26%, compared with 22% in the control group. In the group pretested with CRP, 5% were admitted to hospital, compared with 9% in the control group. These differences were not statistically significant. The main predictors for ordering a CRP test were parents' assessment of seriousness of the illness and the child's temperature. Paediatricians ordered CRP tests less frequently than did other doctors (9% vs 56%, p<0.001).
  
  
  
  Preconsultation screening with CRP of children presenting to out-of-hours services with fever and/or respiratory symptoms does not significantly affect the prescription of antibiotics or referral to hospital.
  
  
  
  NCT02496559; Results.
authors.affiliation: National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Ingrid Keilegavlen
authors.initials: IK
authors.lastname: Rebnord
authors.affiliation: National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway.
authors.forename: Hogne
authors.initials: H
authors.lastname: Sandvik
authors.affiliation: Haukeland University Hospital, Bergen, Norway.
authors.forename: Anders Batman
authors.initials: AB
authors.lastname: Mjelle
authors.affiliation: National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Steinar
authors.initials: S
authors.lastname: Hunskaar
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D039602:After-Hours Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005334:Fever / Q000097:blood / Q000188:drug therapy; D058006:General Practice / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D009664:Norway; D010372:Pediatrics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012140:Respiratory Tract Diseases / Q000097:blood / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: C-reactive protein; PRIMARY CARE; Prescriptions; Referral and Consultation