Antibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training: A Randomized Trial

The Article in Brief

Antibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training: A Randomized Trial

Paul Little , and colleagues

Background Training clinicians in communication skills to explore patients' concerns has been shown reduce antibiotic prescribing for lower respiratory tract infections. In addition, point-of-care testing for C-reactive protein can have diagnostic utility in cases of respiratory tract infection. A study of internet-based physician training for communication skills, including use of an interactive patient booklet, and testing for C-reactive protein previously found that, at 3 months, both interventions reduced antibiotic prescribing. This report examines the effect of the interventions after 12 months.

What This Study Found Although training physicians in communication skills and in testing for C-reactive protein has short-term effectiveness in reducing antibiotic prescriptions, this analysis finds that only communication training remains effective over time. In this six-country study, 246 general practices received internet-based training in patient-centered communication, including use of an interactive patient booklet, and point-of-care testing for C-reactive protein. Participants were cluster randomized to one of four groups: usual care (n=61), training for C-reactive protein point-of-care testing (n=62), training in communication skills and use of patient booklet (n=61), or combined interventions (n=62). At 12 months, antibiotic prescribing was reduced in usual care (from 58 percent at three months to 51 percent at 12 months), but increased in the C-reactive protein testing group (from 35 percent to 43 percent). When compared to three-month data, reductions in prescribing for communication training were maintained at 40 percent (465/1,166). Despite being freely provided, C-reactive protein testing was rarely used, and patient booklets were used only sparingly.

Implications

• The authors suggest that, in routine primary care practice, training clinicians to use CRP testing is likely to yield short-term benefits. Training in enhanced communication skills provides the most useful long-lasting effects.