Peer-reviewed article
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.
Zane Likopa, Anda Kivite-Urtane, Ieva Strele, Jana Pavare ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tested whether giving general practitioners access to rapid C-reactive protein testing and training would improve how they diagnose and treat children with acute infections in Latvia. The intervention increased diagnostic testing significantly, but surprisingly, when GPs received only the training without the test device, they ordered fewer tests. The study found that even when test results suggested antibiotics were not needed, many GPs still prescribed them anyway.
Key points
- Combined intervention (CRP point-of-care testing plus GP education) increased diagnostic testing 11-fold compared to usual care
- Long-term education alone (without continued access to CRP testing) actually decreased diagnostic testing by 26.4%
- Rural practices and those with longer laboratory turnaround times showed the strongest increase in testing when the intervention was available
- Low CRP values, negative Strep A tests, and normal X-rays often failed to stop GPs from prescribing antibiotics
- The intervention did not reliably lead to more appropriate antibiotic prescribing based on test results
Limitations
This is a post hoc analysis of a randomised controlled trial, which may not have been designed to answer all the questions being asked. The study shows what happened with diagnostic testing but does not clearly measure clinical outcomes or patient benefit.
Abstract
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. UNLABELLED: Trial registration: ISRCTN registry - ISRCTN34931655.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Point-of-care C-reactive protein testing device combined with general practitioner education and training
- Population
- Children with acute infections consulting general practitioners across 80 practices in Latvia
Key finding
Diagnostic testing significantly increased in combined intervention group versus usual care (aOR 11.1, 95% CI 8.0-15.3)