Antibiotics: could a ‘fix’ reduce self-management?

Could a ‘fix’ for antibiotic prescribing actually reduce self-management? A GP practice in Hertfordshire just won an NHS Innovation prize for its nurse practitioner-led service offering CRP tests to patients attending with chesty coughs. 

Each four-minute fingerprick test costs £4, plus a £700 annual analyser cost – and it has saved the practice £100 a month. Even more importantly, antibiotic prescribing was reduced by 25%. Re-attendance rates – when patients come back for the same cough – dropped from 24% to 4%. This all sounds excellent! Read more here.

CCGs spent £427million for antibiotics just in the first quarter of 2015/16, so any effective innovations are important. This project fits well with Lord O’Neill’s report recommending there should be more data and diagnostics like the CRP test to reduce inappropriate antibiotic prescribing.

The £10,000 prize will be used to roll the system out across 10 other local practices. But I do hope that the roll-out is also going to look more widely:

  1. Patient satisfaction rates are lower in practices with more frugal prescribing of antibiotics. Does this change when CRP tests are used?
  2. Could pharmacists do the CRP tests more cheaply or more quickly than nurses? Would a pharmacy service work as well?
  3. What is the time-line for the CRP results of those who really do have a bacterial cough? Could this service become so swift that it doesn’t identify those with the earliest bacterial infections – those who need antibiotics? It’s not uncommon for older people, especially those with previous lung disease, to seem to progress into a bacterial infection after what started as a sniffle.
  4. This service doesn’t seem to me to promote self management. Could it paradoxically increase attendances – if all patients decide they want to know if they need antibiotics, even at the very beginning of a cough? Certainly, when I was working in an out-of-hours service, it was not uncommon for fit young people (especially men) who had no significant past illness, to call up saying they had a terrible cough. When I asked for more details, they often told me it was for just one day, and that they had not even tried taking paracetamol or hot fruit drinks, or reduced/stopped smoking. And we can’t always produce immediate solutions for self-limiting problems.

Could the availability of CRP tests actually further medicalise the management of benign and common conditions?



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