DiagnosticsBlood Tests And Better Communication Skills Could Cut Over-prescribing Of Antibiotics
Improving communications skills and the use of a simple blood test could help cut the growing
number of inappropriate prescriptions of antibiotics, a joint Cardiff University trial has
discovered.
In a major new clinical trial, published in the British Medical Journal, a team of researchers from
Cardiff University"s School of Medicine together with researchers from the Maastricht University
Medical Centre in the Netherlands found those GPs in primary care who underwent training in advanced
communications skills and those who made use of a simple blood test prescribed fewer antibiotics for
lower respiratory tract infections, which generally do not respond to antibiotics.
Professor Christopher Butler, Head of Department of Primary Care and Public Health at Cardiff
University who led the trial, said: "As the problem of bacteria resistant to antibiotic treatment
grows, researchers from around the world are seeking ways to improve the quality of antibiotic
prescribing. Prescribing antibiotics only when patients will clearly benefit, reduces the pressure
that drives antibiotic resistance.
"Conditions like acute bronchitis account for some 80% of all lower respiratory tract infections
and despite evidence of little or no benefit from antibiotics, the majority of these patients are
still prescribed antibiotics.
"We know that with the many pressures facing GPs, including worry about leaving pneumonia
untreated, they often give patients "the benefit of the doubt" and prescribe antibiotics. Our
clinical trial therefore sought to evaluate ways antibiotic prescribing could be reduced without
adversely affecting patient recovery or satisfaction with care."
The trial evaluated an "illness focussed" approach, where clinicians seek to better understand
the patient"s illness experience and communicate more effectively about management, and a
"disease focussed" approach, where clinicians focus on diagnosis, in this case, a simple
point-of-care blood test.
The trial randomised 20 general practices in the Netherlands, where 40 GPs managed 431 patients
with lower respiratory tract infection.
Dr Kerry Hood, Director of the South East Wales Trials Unit said, "The results showed that 54% of
GPs practising according to usual care prescribed antibiotics, whereas 27% of those who had been
trained in the advanced communication and 31% of the GPs who used the blood test methods did so.
Only 23% of GPs who were trained in the advanced communication skills and who used the blood test
prescribed antibiotics."
Professor Butler added, "This international collaboration between primary care researchers from
Cardiff and Maastricht has shown that both an "illness focussed" and a "disease focussed"
approach were effective in reducing antibiotic prescribing, but the two approaches combined give the
greatest benefit. We need to both communicate better and improve diagnosis to do the best for our
patients and to preserve antibiotic effectiveness for our children.
"Importantly, the results showed that prescribing fewer antibiotics did not mean that patients
were unwell for longer. Patient"s recovery and satisfaction with care were not compromised by GPs
not prescribing their patient antibiotics."
Citation:
"Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections"
Jochen W L Cals, Christopher C Butler, Rogier M Hopstaken, Kerenza Hood, Geert-Jan Dinant
British Medical Journal (BMJ), 2009; 338:b1374
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Cardiff University