Improved diagnostic management of children with acute infections following the introduction of point-of-care C-reactive protein testing and general practitioner education in Latvia: a post hoc analyses of a randomised controlled intervention study.
Zane Likopa, Anda Kivite-Urtane, Ieva Strele et al.
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In 30 seconds
This post hoc analysis of a randomised controlled intervention study examined diagnostic testing before antibiotic prescribing for children with acute infections seen in 80 general-practitioner practices across Latvia. Practices received access to point-of-care C-reactive protein testing plus GP education, or usual care, with groups switched in a later study period. Testing was more frequent with the combined intervention than with usual care (adjusted odds ratio [aOR] 11.1, 95% CI 8.0-15.3), but declined in the long-term education group (26.4%; aOR 0.5, 95% CI 0.3-0.8). Low CRP, negative Strep A, or normal X-ray results often did not lead GPs to withhold antibiotics.
Key findings
- Combined access to CRP point-of-care testing and GP education increased diagnostic testing versus usual care (aOR 11.1, 95% CI 8.0-15.3).
- Testing declined in the long-term education group (26.4%; aOR 0.5, 95% CI 0.3-0.8).
- The testing increase with the combined intervention was more pronounced in rural practices (aOR 37.6, 95% CI 17.9-79.0) and where laboratory results took longer (aOR 23.2, 95% CI 14.1-38.0).
- Low CRP, negative Strep A, or normal X-ray results often did not persuade GPs to withhold antibiotics.
Why it matters
The findings show that making diagnostic testing more available, alongside clinician education, can substantially change testing before antibiotic decisions in primary care. However, increased testing alone may not ensure that results inform prescribing: the reported mismatch between some reassuring results and antibiotic decisions highlights the importance of interpreting tests in clinical context.
What to keep in mind
This was a post hoc analysis, and the reported increase in testing does not establish that the intervention reduced unnecessary antibiotic prescribing.