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Most patients open to blood testing to avoid unnecessary antibiotics for RTIs
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Most patients from six family medicine clinics seemed willing to have point-of-care blood tests if it helped primary care physicians make antibiotic prescribing decisions for acute respiratory tract infections, according to findings published in the Journal of the American Board of Family Medicine.
“Changes to the culture of antibiotic prescribing and potential introduction of new diagnostic tests require an understanding of patients’ knowledge, views and attitudes,” Malaika Schwartz, MPH, from the department of family medicine at the University of Washington, and colleagues wrote. “While primary care physicians have highlighted a need for improved diagnostic tools to help them guide antibiotic prescribing decisions, no recent attempts have been made to determine patients’ willingness to avoid antibiotics for [respiratory tract infections] or their perceptions of these tests in the United States.”
Researchers surveyed 737 adult patients visiting six family medicine clinics to determine their willingness to include blood tests (venous and point-of-care [POC]), as part of the diagnostic work-up for respiratory tract infections (RTIs), and their knowledge of the value of antibiotics for RTIs. Responses to survey questions about willingness to receive blood tests included “somewhat willing,” “very willing,” “neutral,” “somewhat unwilling” or “very unwilling.”
Although 87.3% of respondents stated they preferred to avoid taking antibiotics for RTIs, 64% of those who had visited a doctor for RTI within the past 12 months had received antibiotics. Assessment of patient knowledge revealed that only 37.9% understood that antibiotics offer the most benefit for bacterial infections.
Overall, 63.1% of respondents were somewhat or very willing to have venous blood drawn and 79% were somewhat or very willing to have a POC fingerstick test to help determine antibiotic use for RTI. The most frequently cited reasons patients gave for willingness to have a fingerstick test were doctor recommendation (68.8%), the speed of the results (53.8%), and if it helped the doctor decide whether antibiotics were needed (41.3%).
According to researchers, the findings suggest disparities related to gender, race, ethnicity and age in both knowledge about antibiotics for RTIs and willingness to consider blood tests for RTIs.
“For family physicians, our results suggest that the majority of adult patients prefer to avoid taking antibiotics for RTIs and that patients are strongly guided by what their family physician recommends in terms of the need for additional testing for RTIs,” Schwartz and colleagues wrote.
“While a fairly substantial body of evidence exists on the effectiveness of [C-reactive protein] POC tests to safely reduce antibiotic use for RTIs in primary care ... to our knowledge no trials of this test have occurred in U.S. primary care settings,” they continued.
The researchers concluded that the results of this and other recent studies support the need for research to evaluate the role and efficacy of office diagnostic tests in U.S. primary care settings to safely reduce antibiotic use. – by Savannah Demko
Disclosures: Schwartz reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Susan C. Bleasdale, MD
In this article, researchers evaluated perceptions of point-of-care testing for C-reactive protein to help make decisions about whether a patient needs antibiotics. Their findings suggest that most patients are willing to consider tests to discover what is wrong with them, which isn’t unexpected. However, for upper respiratory infections, often a physician has the clinical skills to differentiate whether a patient needs antibiotics. Evaluating symptoms and physical exam could be adequate. For example, if you have a patient with a respiratory tract infection that’s likely viral, you prescribe symptomatic relief. If the patient isn’t feeling better, they come back and are re-evaluated and a physician considers additional tests to evaluate the need for further treatment.
Primary care physicians may be under the perception that when patients come in for a visit, they may have to give patients some “deliverable,” such as antibiotics, or testing. When we give patients tips like “get plenty of rest,” and “stay well hydrated,” this may be a rather unsatisfying encounter for both parties, especially for the patient who was expecting an antibiotic and the PCP who feels that all he or she can do is offer them advice. Although they queried patients about perceptions of antibiotic use, it was somewhat biased question; it was not about patient perception of whether antibiotics help them but whether they want treatment that is not recommended by their physician. This article appears to offer a rather non-specific test to fill that perhaps unconscious need to provide a concrete “deliverable” to patients.
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