Lindström Johan, Nordeman Lena, Hagström Bertil
a Närhälsan Primary Health Care Center Lerum , Sweden ;
b Närhälsan, Research and Development Primary Health Care Region Västra Götaland, Research and Development Center Södra Älvsborg, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, Sweden ;
Scand J Prim Health Care. 2015;33(4):275-82. doi: 10.3109/02813432.2015.1114348. Epub 2015 Dec 7.
To explore how C-reactive protein (CRP) tests serve to support physicians in decisions concerning antibiotic prescription to patients with respiratory tract infections (RTI).
Prospective observational study.
Primary health care centres in western Sweden.
Physicians in primary health care. Patients with acute RTI.
Physician willingness to measure CRP, their ability to estimate CRP, and changes in decision-making concerning antibiotic treatment based on error estimate and the physician's opinion of whether CRP measurement was crucial.
Data from 340 consultations were gathered. CRP testing was found to be crucial in 130 cases. In 86% of visits decisions regarding antibiotic prescription were unchanged. Physicians considering CRP crucial and physicians making an error estimate of CRP altered their decisions concerning antibiotic prescription after CRP testing more often than those who considered CRP unnecessary, and those making a more accurate estimate. Physicians changed their decision on antibiotic prescription in 49 cases. In the majority of these 49 cases physicians underestimated CRP levels, and the majority of changes were from "no" to "yes" as to whether to prescribe antibiotics.
CRP is an important factor in the decision on whether to prescribe antibiotics for RTIs. Error estimates of CRP and willingness to measure CRP are important factors leading to physicians changing decisions on antibiotic treatment. Key points There is a generally low antibiotic prescription rate and a high frequency of C-reactive protein (CRP) testing for respiratory tract infections (RTIs) in Sweden. CRP testing was considered essential to further management in 38% of cases. In 86% of visits decisions concerning antibiotic prescription were unchanged. The strongest predictors for revised decisions on antibiotic treatment were error estimates of CRP and the physician's opinion that CRP measurement was crucial.
探讨C反应蛋白（CRP）检测如何辅助医生做出关于呼吸道感染（RTI）患者抗生素处方的决策。
前瞻性观察性研究。
瑞典西部的初级卫生保健中心。
初级卫生保健医生。急性RTI患者。
医生测量CRP的意愿、估计CRP的能力，以及基于误差估计和医生对CRP测量是否关键的看法而在抗生素治疗决策上的变化。
收集了340次会诊的数据。发现130例中CRP检测至关重要。在86%的就诊中，关于抗生素处方的决策未改变。认为CRP关键的医生和对CRP有误差估计的医生在CRP检测后比那些认为CRP不必要的医生以及估计更准确的医生更常改变抗生素处方决策。医生在49例中改变了抗生素处方决策。在这49例中的大多数情况下，医生低估了CRP水平，并且大多数变化是从“不开”抗生素改为“开”抗生素。
CRP是决定是否为RTI患者开抗生素的重要因素。对CRP的误差估计和测量CRP的意愿是导致医生改变抗生素治疗决策的重要因素。要点 在瑞典，呼吸道感染（RTI）的抗生素处方率普遍较低，CRP检测频率较高。38%的病例中，CRP检测被认为对进一步治疗至关重要。86%的就诊中，关于抗生素处方的决策未改变。抗生素治疗决策修订的最强预测因素是对CRP的误差估计以及医生认为CRP测量至关重要。
