Enhanced Communication Skills and C-reactive Protein Point-of-Care Testing for Respiratory Tract Infection: 3.5-year Follow-up of a Cluster Randomized Trial
Enhanced Communication Skills and C-reactive Protein Point-of-Care Testing for Respiratory Tract Infection: 3.5-year Follow-up of a Cluster Randomized Trial
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DOI：
10.1370/afm.1477
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发表时间：
2013-03-01
影响因子：
4.4
通讯作者：
Dinant, Geert-Jan
中科院分区：
文献类型：
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作者：
Cals, Jochen W. L.;de Bock, Leon;Dinant, Geert-Jan
本研究的目的是评估家庭医生使用C-反应蛋白（CRP）即时检测和/或医生培训对呼吸道感染患者门诊就诊率和抗生素处方的长期影响。379例因急性咳嗽就诊于家庭医生的患者（荷兰20例家庭诊所）入组本试验，并获得了随访数据（占原始试验队列的88%）。主要的结果测量指标是每例患者每年平均就诊于家庭医生的呼吸道感染发作次数（PPPY），结果：随访期间呼吸道感染的平均发作次数为100次，平均发作次数为100次。在CRP检测组中上升为0.40 PPPY，在无CRP检测组中上升为0.56 PPPY（P = 0.12）。在沟通技巧训练组中，平均有0.36 PPPY呼吸道感染发作，而在未训练组中，平均为0.57 PPPY（P = 0.09）。在随访期间，CRP检测组中30.7%的呼吸道感染患者接受了抗生素治疗，而未检测组为35.7%（P = 0.36）。接受过沟通技能培训的家庭医生使用抗生素治疗的呼吸道感染占所有呼吸道感染病例的26.3%，而未接受过沟通技能培训的家庭医生治疗的比例为39.1%（P = .02）结论：家庭医生使用CRP即时检测和/或加强沟通技能培训不会显著影响与呼吸道感染相关的就诊率。在随后的3.5年中，接受过增强沟通技能培训的家庭医生的患者在呼吸道感染发作期间的抗生素处方量显着减少。
PURPOSE The purpose of the study was to assess the long-term effect of family physicians' use of C-reactive protein (CRP) point-of-care testing and/or physician training in enhanced communication skills on office visit rates and antibiotic prescriptions for patients with respiratory tract infections.METHODS We conducted a 3.5-year follow-up of a pragmatic, factorial, cluster-randomized controlled trial; 379 patients (20 family practices in the Netherlands) who visited their family physician for acute cough were enrolled in the trial and had follow-up data available (88% of original trial cohort). Main outcome measures were the average number of episodes of respiratory tract infections for which patients visited their family physician per patient per year (PPPY), and the percentage of the episodes for which patients were treated with antibiotics during follow-up.RESULTS The mean number of episodes of respiratory tract infections during follow-up was 0.40 PPPY in the CRP test group and 0.56 PPPY in the no CRP test group (P = .12). In the communication skills training group, there was a mean of 0.36 PPPY episodes of respiratory tract infections, and in the no training group the mean was 0.57 PPPY (P = .09). During follow-up 30.7% of all episodes of respiratory tract infection were treated with antibiotics in the CRP test group compared with 35.7% in the no test group (P = .36). Family physicians trained in communication skills treated 26.3% of all episodes of respiratory tract infection with antibiotics compared with 39.1% treated by family physicians without training in communication skills (P = .02)CONCLUSIONS Family physicians' use of CRP point-of-care testing and/or training in enhanced communication skills did not significantly affect office visit rates related to respiratory tract infections. Patients who saw a family physician trained in enhanced communication skills were prescribed significantly fewer antibiotics during episodes of respiratory tract infection in the subsequent 3.5 years.