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Project

Acute respiratory infection (ARI) in primary care (PC) settings in Europe: point prevalence audit survey (PPAS) of presentation and management.

Background: The resistance to antibiotics is one of the most important causes of death worldwide. 80% of all antibiotics are presribed in primary care settings and acute respiratory infections (CA-ARTI) are the commonest acute reasons for consulting health services in community care setting and for antibiotic use. In clinical trials point of care testing have been proven to be cost effective and could help improve quality of care and patient outcomes. Aim: To record information about patients who seek healthcare for CA-ARTI (e.g. acute cough, sore throat). This will help researchers benchmark patterns of testing and antibiotic prescribing in contrasting European settings simply by observing what happens now in routine care. Design and setting: Prospective audit in 18 European countries. Method: GPs registered patient-, clinical- and management characteristics, and confidence in their antibiotic prescribing decision for patients presenting with sore throat and/or lower RTI (n=4,982). Differences in these characteristics between countries and between pandemic and prepandemic care are described. Factors related to antibiotic prescribing and confidence were analysed using multilevel logistic regression. Results: Care for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. Antibiotic prescribing was related to illness severity, comorbidity, age, fever and 'country', but not to having performed a POC test. In nearly 90% of consultations, GPs were confident in their antibiotic prescribing decision. Conclusion: Despite high confidence in decisions about antibiotic prescribing, there is considerable variation in the primary care of RTI in European countries, with GPs prescribing antibiotics overall more often than is considered appropriate. POC testing may enhance the quality of antibiotic prescribing decisions if it can safely reverse decisions confidently made on clinical grounds alone to prescribe antibiotics.
Date:22 Feb 2022 →  31 Mar 2022
Keywords:INFECTIONS, PRIMARY CARE, ANTIBIOTIC USE, DIAGNOSTIC TESTS
Disciplines:Infectious diseases, Epidemiology
Project type:Service project