28 June 2017

A pilot study into the use of near patient diagnostics in general practice, to help GPs and nurse practitioners prescribe antibiotics for chest infections more precisely, has won a national Public Health England Award.

The study, led by Advanced Nurse Practitioner Liz Cross and guided by Dr Denise Knight at the University’s School of Health and Social Work, piloted CRP (C Reactive Protein) point-of-care testing in Hertfordshire to reduce antibiotic prescribing and number of appointments for treating chest infections. The study has found that these tests reduce the need for antibiotic prescribing as well as the need for follow-up appointments.

CRP testing

CRP testing is a quick and simple finger prick blood test that determines whether infections are more likely viral or bacterial in nature. Results are given to the patient in four minutes, inside the course of a normal patient appointment.

The tests were trialled at Herts Valleys Clinical Commissioning Group over a three-month winter period in five GP practices. The researchers then compared the prescribing rates against three similar local practices using standard care.

Researchers evaluated how often patients were prescribed antibiotics as well as patients’ notes after 28 days to see if they returned either for another appointment, presented to A&E, called out of hours surgeries, required a chest X-ray or were prescribed more antibiotics.

The results showed that those in the testing group were prescribed antibiotics less often and were also less likely to return for an unplanned follow up appointments.

Provisional results indicate the antibiotic prescribing rate for the CRP testing group and control group were 13% and 67% respectively.

In addition, unplanned second appointments for the control group was at 37%, but only 16% for the CRP testing group, and three patients presented to A&E in the control group but none from the CRP testing group.

A practical effective approach

Liz Cross, Visiting Lecturer at the University of Hertfordshire, said:

“Our provisional findings are important because they show that GPs implementing CRP point of care testing are likely to be better able to diagnose and manage chest infections and reduce unplanned follow up appointments. This approach will free up time for other urgent appointments during peak winter months.

“CRP testing is a practical effective approach which gives patients the reassurance that they have had a thorough examination by their local GP or nurse.

“Our next step is to offer CRP point of care testing targeted to our highest prescribing practices to help them reduce their antibiotic prescribing.”

The research team collected their award at Public Health England’s national Antibiotic Guardian Awards in London on 8 June 2017.