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The antibiotic prescription and redemption gap and opportunistic CRP point-of-care testing. A cross-sectional study in primary health care from Eastern Austria

Diskrepanzen zwischen Antibiotikaverschreibungen und dem Einlöseverhalten der Patientinnen und Patienten im Zusammenhang mit CRP-Schnelltests in der allgemeinmedizinischen Versorgung

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Zusammenfassung

Hintergrund

Ziel dieser Studie war die Analyse der Häufigkeit des Gebrauchs von CRP-Schnelltests durch Hausärztinnen und Hausärzte sowie deren Rolle bei der Entscheidung, ob ein Antibiotikum verschrieben werden soll. Ein spezieller Focus wurde bei der Auswertung auf das Antibiotikarezept-Einlöseverhalten der PatientInnen gelegt.

Methodik

Es handelt sich um eine Querschnittsstudie, bei welcher Hausärztinnen und Hausärzte 2,5 Jahre lang ihren CRP-Test-Einsatz dokumentierten. Zusätzlich wurden demographische Daten der PatientInnen, Antibiotikaverschreibungen und Antibiotikarezept-Einlösungen in Relation zu den drei möglichen CRP-Testergebnissen (1: < 10 mg/l, 2: 10–30 mg/l, 3: > 30 mg/l) deskriptiv statistisch ausgewertet.

Ergebnisse

30 Hausärztinnen und Hausärzte dokumentierten 692 CRP-Tests. Die Antibiotika-Verschreibungsrate unterschied sich signifikant zwischen den drei CRP-Testergebnisgruppen (9,2 vs. 71,7 vs. 98,7 %; p < 0,001). Auch unterschieden sich die drei Gruppen signifikant hinsichtlich des Antibiotika-Einlöseverhaltens der PatientInnen (30,8 vs. 62,7 vs. 64,0 %; p = 0,013). 16,3 % der PatientInnen lösten ein Antibiotikum ein, obwohl im Zusammenhang mit dem CRP-Test kein Rezept dokumentiert wurde.

Ausblick

Die CRP-Testergebnisse zeigen einen Zusammenhang sowohl mit den Antibiotikaverschreibungen durch die Ärztinnen und Ärzte als auch mit dem Einlöseverhalten durch die PatientInnen. Auffällig ist, dass fast ein Fünftel derer, die kein Rezept verschrieben bekamen, im Beobachtungszeitraum doch noch ein Antibiotikum einlösten und 36 % derer, die das höchste CRP-Testergebnis hatten, ihr Rezept nicht einlösten.

Summary

Objective

The aim of this study was to analyse the frequency of C-reactive protein (CRP) rapid test use by general practitioners (GPs), the role of the test in the antibiotic treatment decisions and the efficacy of the test in a primary care setting, with special emphasis on the redemption rate of antibiotic prescriptions.

Design

For this cross-sectional study, GPs documented their CRP test use for 2.5 years. In addition, demographic and the antibiotic prescription and redemption data of the patients were documented. Three groups were clustered according to the three possible CRP test results (1: < 10 mg/l, 2: 10–30 mg/l, 3: > 30 mg/l); analyses were conducted by using descriptive statistical methods and tests.

Results

Thirty GPs documented 692 initial CRP tests. The antibiotic prescription rate was 9.2 % for the first, 71.7 % for the second and 98.7 % for the third group (p < 0.001). A difference between the patients of the three CRP groups according to the redemption rate of antibiotic prescriptions (30.8 vs. 62.7 vs. 64.0 %; p = 0.013) could be found, with the lowest rate in the first group. Overall, 16.3 % of the patients filled an antibiotic at a pharmacy that was not in accordance with the CRP test result documentation form.

Conclusion

The CRP test results show an association with both the antibiotic prescribing and redemption behaviour. Noticeable was the antibiotic redemption behaviour of the patients: 36 % of patients with a CRP test result over 30 did not fill the antibiotic prescribed which is an important finding related to patients adherence and of special interest due to the fact that none of these patients had a hospital admission afterwards. On the contrary, nearly one-fifth of the patients who did not get an antibiotic in connection with the CRP test result finally filled an antibiotic prescription.

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Conflict of interest

All authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalg. 15/1st floor, 1090, Vienna, Austria

    Kathryn Hoffmann MD, MPH,  Anna Katharina Leifheit &  Manfred Maier

  2. BGKK-Social health insurance company of the county Burgenland, Unit for Health Care Economics, Eisenstadt, Austria

    Berthold Reichardt

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  1. Kathryn Hoffmann MD, MPH
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  2. Anna Katharina Leifheit
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  3. Berthold Reichardt
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  4. Manfred Maier
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Correspondence to Kathryn Hoffmann MD, MPH.

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Hoffmann, K., Leifheit, A., Reichardt, B. et al. The antibiotic prescription and redemption gap and opportunistic CRP point-of-care testing. A cross-sectional study in primary health care from Eastern Austria. Wien Klin Wochenschr 125, 105–110 (2013). https://doi.org/10.1007/s00508-013-0323-5

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