Abstract
Background Antibiotics are overprescribed for non-severe acute infections in children in primary care.
Aim To explore two different interventions that may reduce inappropriate antibiotic prescribing for non-severe acute infections.
Design and setting A cluster randomised, factorial controlled trial in primary care, in Flanders, Belgium.
Method Family physicians (FPs) enrolled children with non-severe acute infections into this study. The participants were allocated to one of four intervention groups according to whether the FPs performed: (1) a point-of-care C-reactive protein test (POC CRP); (2) a brief intervention to elicit parental concern combined with safety net advice (BISNA); (3) both POC CRP and BISNA; or (4) usual care (UC). Guidance on the interpretation of CRP was not provided. The main outcome was the immediate antibiotic prescribing rate. A mixed logistic regression was performed to analyse the data.
Results In this study 2227 non-severe acute infections in children were registered by 131 FPs. In comparison with UC, POC CRP did not influence antibiotic prescribing, (adjusted odds ratio [AOR] 1.01, 95% confidence interval [CI] = 0.57 to 1.79). BISNA increased antibiotic prescribing (AOR 2.04, 95% CI = 1.19 to 3.50). In combination with POC CRP, this increase disappeared.
Conclusion Systematic POC CRP testing without guidance is not an effective strategy to reduce antibiotic prescribing for non-severe acute infections in children in primary care. Eliciting parental concern and providing a safety net without POC CRP testing conversely increased antibiotic prescribing. FPs possibly need more training in handling parental concern without inappropriately prescribing antibiotics.
- children
- cluster randomised controlled trial
- inappropriate prescribing
- physician–patient communication
- point-of-care testing
- primary care
- Received June 15, 2017.
- Revision requested July 31, 2017.
- Accepted October 2, 2017.
- © British Journal of General Practice 2018