Improved diagnostic management of children with acute infections following the introduction of point-of-care C-reactive protein testing and general practitioner education in Latvia: a post hoc analyses of a randomised controlled intervention study

OBJECTIVE: In order to reduce unnecessary antibiotic prescribing, diagnostic processes require improvement for children in primary care.

DESIGN: Post hoc analyses of randomised controlled intervention study.

SETTING: Eighty general practitioner (GP) practices throughout Latvia.

INTERVENTION: In the first study period, one GP group received combined interventions (access to CRP POCT and GP education), while the second GP group continued usual care (control group). In the second study period, the GP groups were switched - previous control group received combined intervention, but previous intervention group re-established usual care, but the long-term education effect was evaluated in this group.

SUBJECTS: Children with acute infections consulted by a GP.

MAIN OUTCOME: Impact of combined intervention and long-term education on testing level (CRP, full blood count, Strep A test, influenza test, urinalysis and X-ray) before antibiotic prescribing. Patient- and GPs- related predictors (including practice location and access to laboratory services) of diagnostic testing were also analysed. Secondary outcome was antibiotic prescribing according to the test results.

RESULTS: Diagnostic testing was significantly increased in the combined intervention group versus the usual care group (aOR 11.1, 95% CI 8.0-15.3); however, it was decreased in the long-term education group (26.4%) (aOR 0.5, 95% CI 0.3-0.8). Rural practices and a longer expected time of laboratory results were associated with a more pronounced increase in diagnostic testing in the combined intervention group (aOR 37.6, 95% CI 17.9-79.0; aOR 23.2, 95% CI 14.1-38.0, respectively). It was found that a low CRP value, negative Strep A test or normal X-ray often did not convince GPs to withhold antibiotics.

CONCLUSION: The availability of CRP POCT and GP education results in a much higher level of diagnostic testing prior to antibiotic prescribing, especially in rural regions. Further improvements in more rational testing and the interpretation of results to guide appropriate antibiotic prescribing are essential.