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Blood tests and better communication skills could cut over-prescribing of antibiotics

18 May 2009

Improving communications skills and the use of a simple blood test could help cut the growing number of inappropriate prescriptions of antibiotics, a joint Cardiff University trial has discovered.

In a major new clinical trial, published in the British Medical Journal, a team of researchers from Cardiff University’s School of Medicine together with researchers from the Maastricht University Medical Centre in the Netherlands found those GPs in primary care who underwent training in advanced communications skills and those who made use of a simple blood test prescribed fewer antibiotics for lower respiratory tract infections, which generally do not respond to antibiotics.

Professor Christopher Butler, Head of Department of Primary Care and Public Health at Cardiff University who led the trial, said: "As the problem of bacteria resistant to antibiotic treatment grows, researchers from around the world are seeking ways to improve the quality of antibiotic prescribing. Prescribing antibiotics only when patients will clearly benefit, reduces the pressure that drives antibiotic resistance.

"Conditions like acute bronchitis account for some 80% of all lower respiratory tract infections and despite evidence of little or no benefit from antibiotics, the majority of these patients are still prescribed antibiotics.

"We know that with the many pressures facing GPs, including worry about leaving pneumonia untreated, they often give patients "the benefit of the doubt" and prescribe antibiotics. Our clinical trial therefore sought to evaluate ways antibiotic prescribing could be reduced without adversely affecting patient recovery or satisfaction with care."

The trial evaluated an ‘illness focussed’ approach, where clinicians seek to better understand the patient’s illness experience and communicate more effectively about management, and a ‘disease focussed’ approach, where clinicians focus on diagnosis, in this case, a simple point-of-care blood test.

The trial randomised 20 general practices in the Netherlands, where 40 GPs managed 431 patients with lower respiratory tract infection.

Dr Kerry Hood, Director of the South East Wales Trials Unit said, "The results showed that 54% of GPs practising according to usual care prescribed antibiotics, whereas 27% of those who had been trained in the advanced communication and 31% of the GPs who used the blood test methods did so. Only 23% of GPs who were trained in the advanced communication skills and who used the blood test prescribed antibiotics."

Professor Butler added, "This international collaboration between primary care researchers from Cardiff and Maastricht has shown that both an ‘illness focussed’ and a ‘disease focussed’ approach were effective in reducing antibiotic prescribing, but the two approaches combined give the greatest benefit. We need to both communicate better and improve diagnosis to do the best for our patients and to preserve antibiotic effectiveness for our children.

"Importantly, the results showed that prescribing fewer antibiotics did not mean that patients were unwell for longer. Patient’s recovery and satisfaction with care were not compromised by GPs not prescribing their patient antibiotics."

1. Jochen W L Cals, Christopher C Butler, Rogier M Hopstaken, Kerenza Hood, Geert-Jan Dinant - 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 was published in the British Medical Journal (BMJ), 2009; 338:b1374

A full copy of the paper is available here

Additional information is also available at: www.cf.ac.uk/sewtu. The South East Wales Trials Unit (SEWTU) helped design and analyse the trial. The study of common infections is a major theme for SEWTU, and it is implementing several trials and observational studies in this area.

2. School of Medicine

Cardiff University’s School of Medicine is a significant contributor to healthcare in Wales, a major provider of professional staff for the National Health Service and an international centre of excellence for research, delivering substantial health benefits locally and internationally. The school’s 800 staff include 500 research and academic staff who teach more than 2,000 students, including 1,110 postgraduate students.

The School is based at the Heath Park Campus, a site it shares with the University Hospital of Wales, the third largest university hospital in the UK. The School has an all-Wales role, contributing greatly to promoting, enhancing and protecting the nation’s health.

A key partner in this role is the National Health Service (NHS) in Wales, with which the School is linked at all levels. This mutual dependency is illustrated by the teaching of medical undergraduates in more than 150 hospitals located in all of Wales’ health authorities. The medical curriculum followed at the School enables students to acquire and apply knowledge, skills, judgement and attitudes appropriate to delivering a high standard of professional care. Around 300 new doctors currently graduate from the School every year and the Welsh Assembly Government has invested substantially in new teaching facilities to increase this number further

3. Cardiff University

Cardiff University is recognised in independent government assessments as one of Britain’s leading teaching and research universities and is a member of the Russell Group of the UK’s most research intensive universities. Among its academic staff are two Nobel Laureates, including the winner of the 2007 Nobel Prize for Medicine, Professor Sir Martin Evans.

Founded by Royal Charter in 1883, today the University combines impressive modern facilities and a dynamic approach to teaching and research. The University’s breadth of expertise in research and research-led teaching encompasses: the humanities; the natural, physical, health, life and social sciences; engineering and technology; preparation for a wide range of professions; and a longstanding commitment to lifelong learning.

Visit the University website at: www.cardiff.ac.uk

Dr Christopher C Butler

Professor of Primary Care Medicine, Cardiff University

Head of Department of Primary Care and Public Health

Cardiff University

Tel: 029 2068 7168

E-mail: ButlerCC@cardiff.ac.uk

Or

Chris Jones

Communications & International Relations Division

Cardiff University

Tel: 029 20 874731

E-mail: jonec83@cardiff.ac.uk

CJ

Medic11Antibiotics