Evidence map›Paper›PMID 19416992›Full record

Trial reportBMJ (Clinical research ed.)2009

Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial.

Jochen W L Cals, Christopher C Butler, Rogier M Hopstaken, Kerenza Hood, Geert-Jan Dinant

Open access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 218 papers, 20 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
218citing papers in PubMed, 20 pooled it
38.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

218 citing papers in PubMed, 20 syntheses or guidelines pooled it, 505 citations in OpenAlex.

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  7. Procalcitonin as a Biomarker in Rhinosinusitis: A Systematic Review.American journal of rhinology & allergy · 2019
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  19. Reducing antibiotic prescribing for children with respiratory tract infections in primary care: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2013
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158 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 2 countries.

Jochen W L CalsDepartment of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, Netherlands. j.cals@hag.unimaas.nl
Christopher C Butler
Rogier M Hopstaken
Kerenza Hood
Geert-Jan Dinant
Cardiff University · GBMaastricht University Medical Centre · NLMaastricht University · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the effect of general practitioner testing for C reactive protein (disease approach) and receiving training in enhanced communication skills (illness approach) on antibiotic prescribing for lower respiratory tract infection.

designPragmatic, 2x2 factorial, cluster randomised controlled trial.

setting20 general practices in the Netherlands.

participants40 general practitioners from 20 practices recruited 431 patients with lower respiratory tract infection.

main outcome measuresThe primary outcome was antibiotic prescribing at the index consultation. Secondary outcomes were antibiotic prescribing during 28 days' follow-up, reconsultation, clinical recovery, and patients' satisfaction and enablement.

interventionsGeneral practitioners' use of C reactive protein point of care testing and training in enhanced communication skills separately and combined, and usual care.

resultsGeneral practitioners in the C reactive protein test group prescribed antibiotics to 31% of patients compared with 53% in the no test group (P=0.02). General practitioners trained in enhanced communication skills prescribed antibiotics to 27% of patients compared with 54% in the no training group (P<0.01). Both interventions showed a statistically significant effect on antibiotic prescribing at any point during the 28 days' follow-up. Clinicians in the combined intervention group prescribed antibiotics to 23% of patients (interaction term was non-significant). Patients' recovery and satisfaction were similar in all study groups.

conclusionBoth general practitioners' use of point of care testing for C reactive protein and training in enhanced communication skills significantly reduced antibiotic prescribing for lower respiratory tract infection without compromising patients' recovery and satisfaction with care. A combination of the illness and disease focused approaches may be necessary to achieve the greatest reduction in antibiotic prescribing for this common condition in primary care.

trial registrationCurrent Controlled Trials ISRCTN85154857.

Indexed as

AdultAnti-Bacterial AgentsBiomarkersCluster AnalysisCommunicationC-Reactive ProteinFamily PracticeFemaleHumansMalePatient SatisfactionPoint-of-Care SystemsPractice Patterns, Physicians'Professional CompetenceRespiratory Tract InfectionsAnti-Bacterial AgentsBiomarkersC-Reactive Protein

Identifiers

PMID19416992
PMCPMC2677640
OpenAlexW2034781418

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.