title: Microbiological point of care testing before antibiotic prescribing in primary care: considerable variations between practices.
abstract: Point-of-care testing (POCT) in primary care may improve rational antibiotic prescribing. We examined use of POCT in Denmark, including patient- and general practitioner (GP)-related predictors.
  
  
  
  We linked nationwide health care databases to assess POCT use (C-reactive protein (CRP), group A streptococcal (GAS) antigen swabs, bacteriological cultures, and urine test strips) per 1,000 overall GP consultations, 2004-2013. We computed odds ratios (OR) of POCT in patients prescribed antibiotics according to patient and GP age and sex, GP practice type, location, and workload.
  
  
  
  The overall use of POCT in Denmark increased by 45.8% during 2004-2013, from 147.2 per 1,000 overall consultations to 214.8. CRP tests increased by 132%, bacteriological cultures by 101.7% while GAS swabs decreased by 8.6%. POCT preceded 28% of antibiotic prescriptions in 2004 increasing to 44% in 2013. The use of POCT varied more than 5-fold among individual practices, from 54.9 to 394.7 per 1,000 consultations in 2013. POCT use varied substantially with patient age, and males were less likely to receive POCT than females (adjusted OR = 0.75, 95% CI 0.74-0.75) driven by usage of urine test strips among females (18% vs. 7%). Odds of POCT were higher among female GPs and decreased with higher GP age, with lowest usage among male GPs >60 years. GP urban/rural location and workload had little impact.
  
  
  
  GPs use POCT increasingly with the highest use among young female GPs. In 2013, 44% of all antibiotic prescriptions were preceded by POCT but testing rates vary greatly across individual GPs.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark. steffenhaldrup@au.dk.|Department of General Practice, Institute of Public Health, Aarhus University, Aarhus, Denmark. steffenhaldrup@au.dk.
authors.forename: Steffen
authors.initials: S
authors.lastname: Haldrup
authors.affiliation: Department of Clinical Epidemiology, Aarhus University, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
authors.forename: Reimar W
authors.initials: RW
authors.lastname: Thomsen
authors.affiliation: Department of General Practice, Institute of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Flemming
authors.initials: F
authors.lastname: Bro
authors.affiliation: Antimicrobial Resistance Reference Laboratory and Surveillance Unit, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Robert
authors.initials: R
authors.lastname: Skov
authors.affiliation: Section and Research Unit of General Practice, Department of Public Health, Copenhagen University, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Bjerrum
authors.affiliation: Department of Clinical Epidemiology, Aarhus University, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark. mette.soegaard@rn.dk.
authors.forename: Mette
authors.initials: M
authors.lastname: Søgaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D046508:Culture Techniques; D003718:Denmark; D005260:Female; D058005:General Practitioners; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D000067716:Point-of-Care Testing / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012737:Sex Factors; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D013297:Streptococcus pyogenes; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: Antibiotic; General practice; Infection; Point-of-care