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The Use of CRP Tests in Patients with Respiratory Tract Infections in Primary Care in Sweden Can Be Questioned
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
Department of Public Health and Caring Sciences/Family Medicine, Uppsala University, Uppsala.
Department of Infectious Diseases, University Hospital, Malmö.
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2004 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 36, no 3, 192-197 p.Article in journal (Refereed) Published
Abstract [en]

A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1 week in November in 2000 and 2002 respectively. As a part of the study, the use and results of C-reactive protein (CRP) tests in relation to duration of symptoms and antibiotic prescribing in 6778 patients assigned a diagnosis of respiratory tract infections were analysed. In almost half (42%) of the patients, a CRP test was performed. The majority of CRP tests (69%) were performed in patients assigned diagnosis upper respiratory tract infection, where the test is not recommended. Overall, there was a minor decrease in antibiotic prescribing when CRP was used (41%), in comparison to 44% of the patients where no CRP was performed (p<0.01). Patients assigned diagnoses implying a bacterial aetiology were prescribed antibiotics irrespective of result of CRP or length of symptoms before consultation. For patients assigned viral diagnoses, antibiotic prescribing increased with increasing duration of symptoms and increasing value of CRP. The use of CRP decreased antibiotic prescribing in patients assigned to viral diagnoses and with longstanding symptoms (p<0.001). However, 59% of the patients assigned viral diagnoses with CRP≥25 received antibiotics, which seems to indicate a misinterpretation of CRP and a non-optimal use of antibiotics.

Place, publisher, year, edition, pages
2004. Vol. 36, no 3, 192-197 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13637DOI: 10.1080/00365540410019372OAI: diva2:21091
Available from: 2003-03-29 Created: 2003-03-29 Last updated: 2009-02-05
In thesis
1. Rules of Thumb and Management of Common Infections in General Practice
Open this publication in new window or tab >>Rules of Thumb and Management of Common Infections in General Practice
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis deals with problem solving of general practitioners (GPs), which is explored with different methods and from different perspectives. The general aim was to explore and describe rules of thumb and to analyse the management of respiratory and urinary tract infections (RTI and UTI) in general practice in Sweden. The results are based upon focus group interviews concerning rules of thumb and a prospective diagnosis-prescription study concerning the management of patients allocated a diagnosis of RTI or UTI. In addition unpublished data are given from structured telephone interviews concerning specific rules of thumb in acute sinusitis and prevailing cough.

GPs were able to verbalize their rules of thumb, which could be called tacit knowledge. A specific set of rules of thumb was used for rapid assessment when emergency and psychosocial problems were identified. Somatic problems seemed to be the expected, normal state. In the further consultation the rules of thumb seemed to be used in an act of balance between the individual and the general perspective. There was considerable variation between the rules of thumb of different GPs for patients with acute sinusitis and prevailing cough. In their rules of thumb the GPs seemed to integrate their medical knowledge and practical experience of the consultation. A high number of near-patient antigen tests to probe Streptococcus pyogenes (Strep A tests) and C-reactive protein (CRP) tests were performed in patients, where testing was not recommended. There was only a slight decrease in antibiotic prescribing in patients allocated a diagnosis of RTI examined with CRP in comparison with patients not tested. In general, the GPs in Sweden adhered to current guidelines for antibiotic prescribing. Phenoxymethylpenicillin (PcV) was the preferred antibiotic for most patients allocated a diagnosis of respiratory tract infection.

In conclusion, the use of rules of thumb might explain why current practices prevail in spite of educational efforts. One way to change practice could be to identify and evaluate rules of thumb used by GPs and disseminate well adapted rules. The use of diagnostic tests in patients with infectious illnesses in general practice needs critical appraisal before introduction as well as continuing surveillance. The use of rules of thumb by GPs might be one explanation for variation in practice and irrational prescribing of antibiotics in patients with infectious conditions.

Place, publisher, year, edition, pages
Institutionen för hälsa och samhälle, 2004
Linköping University Medical Dissertations, ISSN 0345-0082 ; 840
General practice, rules of thumb, decision making, respiratory tract infections, urinary tract infections, diagnostic tests, C-reactive protein test, antibiotic prescribing
National Category
Urology and Nephrology
urn:nbn:se:liu:diva-5183 (URN)91-7373-812-3 (ISBN)
Public defence
2004-03-12, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (English)
On the day of the public defence the status of the articles IV and V was: Accepted.Available from: 2003-03-29 Created: 2003-03-29

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