O'Neill Katherine, Fleming Glenda, Scott Michael, Plant Gillian, Varma Sumanthra
PhD, BSc. Senior Research and Innovation Programme Manager, Medicines Optimisation and Innovation Centre, Northern Health and Social Care Trust, Northern Ireland.
Deputy Director, Medicines Optimisation and Innovation Centre, Northern Health and Social Care Trust, Northern Ireland.
Pharm Pract (Granada). 2022 Oct-Dec;20(4):2711. doi: 10.18549/PharmPract.2022.4.2711. Epub 2022 Oct 10.
Whether or not to prescribe an antibiotic is a key issue for clinicians treating respiratory tract infection (RTI) in the community. Measurement of C-reactive protein (CRP) in community pharmacy may help to differentiate viral and self-limiting infections from more serious bacterial infections.
To pilot POC CRP testing for suspected RTI within community pharmacy in Northern Ireland (NI).
POC CRP testing was piloted in 17 community pharmacies linked to 9 general practitioner (GP) practices in NI. The service was available to adults presenting to their community pharmacy with signs and symptoms of RTI. The pilot (between October 2019 and March 2020) was stopped early due to Coronavirus-19 (COVID-19).
During the pilot period, 328 patients from 9 GP practices completed a consultation. The majority (60%) were referred to the pharmacy from their GP and presented with <3 symptoms (55%) which had a duration of up to 1 week (36%). Most patients (72%) had a CRP result of <20mg/L. A larger proportion of patients with a CRP test result between 20mg/L and 100mg/L and >100mg/L, were referred to the GP when compared to patients with a CRP test result of <20mg/L. Antimicrobial prescribing rates were studied in a subgroup (n=30) from 1 practice. Whilst the majority (22/30; 73%) had a CRP test result of <20mg/L, 50%, (15/30) of patients had contact with the GP in relation to their acute cough and 43% (13/30) had an antibiotic prescribed within 5 days. The stakeholder and patient survey reported positive experiences.
This pilot was successful in introducing POC CRP testing in keeping with National Institute of Health and Care Excellence (NICE) recommendations for the assessment of non-pneumonic lower RTIs and both stakeholders and patients reported positive experiences. A larger proportion of patients with a possible or likely bacterial infection as measured by CRP were referred to the GP, compared to patients with a normal CRP test result. Although stopped early due to COVID-19, the outcomes provide an insight and learning for the implementation, scale up and optimization of POC CRP testing in community pharmacy in NI.
对于在社区治疗呼吸道感染（RTI）的临床医生而言，是否开具抗生素是一个关键问题。在社区药房检测C反应蛋白（CRP）可能有助于区分病毒感染和自限性感染与更严重的细菌感染。
在北爱尔兰（NI）的社区药房对疑似RTI进行即时检验（POC）CRP检测试点。
在NI与9家全科医生（GP）诊所相关联的17家社区药房开展POC CRP检测试点。该服务面向因RTI的体征和症状前往社区药房就诊的成年人。由于冠状病毒病（COVID-19），试点（2019年10月至2020年3月）提前终止。
在试点期间，来自9家GP诊所的328名患者完成了会诊。大多数（60%）是由其GP转诊至药房的，出现<3种症状（55%），症状持续时间长达1周（36%）。大多数患者（72%）的CRP结果<20mg/L。与CRP检测结果<20mg/L的患者相比，CRP检测结果在20mg/L至100mg/L之间以及>100mg/L的患者中，有更大比例被转诊至GP。在来自1家诊所的一个亚组（n = 30）中研究了抗菌药物处方率。虽然大多数（22/30；73%）的CRP检测结果<20mg/L，但50%（15/30）的患者因急性咳嗽与GP有接触，43%（13/30）的患者在5天内开具了抗生素。利益相关者和患者调查反馈了积极的体验。
该试点成功引入了符合英国国家卫生与临床优化研究所（NICE）对非肺炎性下呼吸道感染评估建议的POC CRP检测，利益相关者和患者均反馈了积极的体验。与CRP检测结果正常的患者相比，通过CRP检测出可能或很可能患有细菌感染的患者中有更大比例被转诊至GP。尽管由于COVID-19提前终止，但这些结果为NI社区药房实施、扩大规模和优化POC CRP检测提供了见解和经验教训。
