Comment on ‘Influence of point-of-care C-reactive protein testing on antibiotic prescription habits in primary care in the Netherlands’ by Schuijt et al.

Comment on ‘Influence of point-of-care C-reactive protein testing on antibiotic prescription... Family Practice, 2018, 1–1 doi:10.1093/fampra/cmy046 Letter to the Editor Comment on ‘Influence of point-of-care C-reactive protein testing on antibiotic prescription habits in primary care in the Netherlands’ by Schuijt et al. † † ,† Anne van den Berg , Bart Oole , Wendelien H van der Gaag* and Gijs Elshout Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands Both authors contributed equally. *Correspondence to Wendelien H van der Gaag, Department of General Practice, Erasmus University Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands; E-mail: w.vandergaag@erasmusmc.nl Dear Sir, treated with antibiotics. Or vice versa, that the GP refrained from With great interest, we read the article of Schuijt et al. about guide- antibiotics in severely ill patients with a low POC-CRP value. Hence, line compliance in point-of-care (POC) testing for C-reactive pro- not taking this ‘severity of disease’ factor into account, could poten- tein (CRP) in primary care, and the influence of CRP results on tially lead to over- (or under) diagnosis and consequently over- (or antibiotic prescription (1). Guideline compliance is an important under) use of antibiotic treatment. criterion when implementing a new POC test because misuse could Second, one of the strengths of this study is, as the authors men- lead to incorrect interpretation of results and inappropriate fur- tioned, that it represents a realistic reflection of the everyday prac- ther medical management. We fully endorse the relevance of this tice in primary care. We agree with that to a certain extent, given topic, since POC-CRP testing has been implemented in primary care the pragmatic nature of the study design. However, GPs received a in the Netherlands and has quickly become common practice in training on the indications for and interpretation of the POC-CRP daily general practitioner (GP) care. However, research before and measurements prior to the study. Therefore, it is likely that the GPs after implementation is scarce; and the evidence is still limited. In in the study were more aware of the indications for POC-CRP test- order to fully appreciate the results found, we have some additional ing than GPs in general practice, which may hamper generalizability questions. of the results. We wondered, what was the authors’ reason to choose First, when assessing guideline compliance, the authors only for a training for GPs? discussed whether patient symptoms (for example cough) were in In conclusion, Schuijt et  al. provided valuable results on POC- accordance with the guidelines of the Dutch College of General CRP testing in daily GP practice. However, with additional infor- Practitioners (DCGP), but they did not mention the degree of illness. mation in regards to the questions raised above, the true additional However, like the authors already addressed in the article, POC-CRP effect of POC-CRP testing on medical management in general prac- testing is only indicated for moderately ill patients. Therefore guide- tice can be further elucidated. line compliance in POC-CRP testing as concluded in this article may be somewhat simplified. This might be one of the reasons for the References high rate (92%) of guideline compliance that was found, as opposed 1. Schuijt TJ, Boss DS, Musson REA, Demir AY. Influence of point-of-care to 41% in Minnaard et al. (2). C-reactive protein testing on antibiotic prescription habits in primary care Do the authors have information on degree of illness of patients? in the Netherlands. Fam Pract 2018; 35: 179–85. If so, it would be interesting to assess the guideline compliance in 2. Minnaard MC, van de Pol AC, Hopstaken RM et  al. C-reactive protein concordance with the severity of the disease. This would also give point-of-care testing and associated antibiotic prescribing. Fam Pract the opportunity to review if low risk patients were unnecessarily 2016; 33: 408–13. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Downloaded from https://academic.oup.com/fampra/advance-article-abstract/doi/10.1093/fampra/cmy046/5003202 by Ed 'DeepDyve' Gillespie user on 17 July 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Family Practice Oxford University Press

Comment on ‘Influence of point-of-care C-reactive protein testing on antibiotic prescription habits in primary care in the Netherlands’ by Schuijt et al.

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© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Abstract

Family Practice, 2018, 1–1 doi:10.1093/fampra/cmy046 Letter to the Editor Comment on ‘Influence of point-of-care C-reactive protein testing on antibiotic prescription habits in primary care in the Netherlands’ by Schuijt et al. † † ,† Anne van den Berg , Bart Oole , Wendelien H van der Gaag* and Gijs Elshout Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands Both authors contributed equally. *Correspondence to Wendelien H van der Gaag, Department of General Practice, Erasmus University Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands; E-mail: w.vandergaag@erasmusmc.nl Dear Sir, treated with antibiotics. Or vice versa, that the GP refrained from With great interest, we read the article of Schuijt et al. about guide- antibiotics in severely ill patients with a low POC-CRP value. Hence, line compliance in point-of-care (POC) testing for C-reactive pro- not taking this ‘severity of disease’ factor into account, could poten- tein (CRP) in primary care, and the influence of CRP results on tially lead to over- (or under) diagnosis and consequently over- (or antibiotic prescription (1). Guideline compliance is an important under) use of antibiotic treatment. criterion when implementing a new POC test because misuse could Second, one of the strengths of this study is, as the authors men- lead to incorrect interpretation of results and inappropriate fur- tioned, that it represents a realistic reflection of the everyday prac- ther medical management. We fully endorse the relevance of this tice in primary care. We agree with that to a certain extent, given topic, since POC-CRP testing has been implemented in primary care the pragmatic nature of the study design. However, GPs received a in the Netherlands and has quickly become common practice in training on the indications for and interpretation of the POC-CRP daily general practitioner (GP) care. However, research before and measurements prior to the study. Therefore, it is likely that the GPs after implementation is scarce; and the evidence is still limited. In in the study were more aware of the indications for POC-CRP test- order to fully appreciate the results found, we have some additional ing than GPs in general practice, which may hamper generalizability questions. of the results. We wondered, what was the authors’ reason to choose First, when assessing guideline compliance, the authors only for a training for GPs? discussed whether patient symptoms (for example cough) were in In conclusion, Schuijt et  al. provided valuable results on POC- accordance with the guidelines of the Dutch College of General CRP testing in daily GP practice. However, with additional infor- Practitioners (DCGP), but they did not mention the degree of illness. mation in regards to the questions raised above, the true additional However, like the authors already addressed in the article, POC-CRP effect of POC-CRP testing on medical management in general prac- testing is only indicated for moderately ill patients. Therefore guide- tice can be further elucidated. line compliance in POC-CRP testing as concluded in this article may be somewhat simplified. This might be one of the reasons for the References high rate (92%) of guideline compliance that was found, as opposed 1. Schuijt TJ, Boss DS, Musson REA, Demir AY. Influence of point-of-care to 41% in Minnaard et al. (2). C-reactive protein testing on antibiotic prescription habits in primary care Do the authors have information on degree of illness of patients? in the Netherlands. Fam Pract 2018; 35: 179–85. If so, it would be interesting to assess the guideline compliance in 2. Minnaard MC, van de Pol AC, Hopstaken RM et  al. C-reactive protein concordance with the severity of the disease. This would also give point-of-care testing and associated antibiotic prescribing. Fam Pract the opportunity to review if low risk patients were unnecessarily 2016; 33: 408–13. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Downloaded from https://academic.oup.com/fampra/advance-article-abstract/doi/10.1093/fampra/cmy046/5003202 by Ed 'DeepDyve' Gillespie user on 17 July 2018

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Family PracticeOxford University Press

Published: May 24, 2018

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