Abstract
BackgroundPoint-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.MethodsWe 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.ResultsThe 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.ConclusionGPs 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.
Highlights
Point-of-care testing (POCT) in primary care may improve rational antibiotic prescribing
Except for 2% of the population, all Danes are enlisted with a particular general practice of their choice and all services provided to this population are recorded through activity codes in Patient characteristics We categorized patients according to sex, age (0–4, 5–9, 10–14, 15–19, 20–39, 40–64, 65–79, and ≥80 years), and prescribed antibiotics categorized as; tetracycline (J01AA), beta-lactamase sensitive penicillin (J01CE), penicillin with extended spectrum (J01CA), beta-lactamase resistant penicillin (J01CF), combinations of penicillin incl. betalactamase inhibitors (J01CR), sulphonamide and trimethoprim (J01E), macrolide, lincosamide and streptogamin (J01F), quinolone (J01MA), and other antibiotics (J01D, G, X)
We excluded 5,496,924 prescriptions issued by other authorities than general practitioner (GP) in the primary health care, for instance doctors from the emergency service and specialists, and 1,608,012 prescriptions due to incomplete data, e.g., missing information about the issuing GP
Summary
Point-of-care testing (POCT) in primary care may improve rational antibiotic prescribing. Studies from Sweden and Switzerland have shown that approximately 42% of patients consulting a GP for an acute respiratory tract infection receive a CRP-test [16, 25]. Older patients, those with higher education, and those with more discomfort are more likely to receive testing [16]. There is limited population-based information on the prevalence and time trends of use of POCT before antibiotic prescribing in primary care and about what characterizes patients and GPs who use POCT. We undertook a nationwide population-based study to examine the use of POCT in relation to antibiotic prescribing in the Danish primary health care sector in 2004–2013, and investigated patient and GP-related predictors for use of POCT
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