Impact of a Rapid Point of Care Test for Influenza on Guideline Consistent Care and Antibiotic Use.

Anti-Bacterial Agents / therapeutic use Antiviral Agents / therapeutic use Guideline Adherence Humans Influenza, Human / diagnosis Non-Randomized Controlled Trials as Topic Point-of-Care Testing / statistics & numerical data Polymerase Chain Reaction / statistics & numerical data Prospective Studies
Antibiotics Antiviral Agents Diagnostic Tests Influenza Point of Care Testing Polymerase Chain Reaction

Journal

Journal of the American Board of Family Medicine : JABFM
ISSN: 1558-7118
Titre abrégé: J Am Board Fam Med
Pays: United States
ID NLM: 101256526

Informations de publication

Date de publication:
Historique:
received: 28 06 2018
revised: 01 11 2018
accepted: 07 11 2018
entrez: 10 3 2019
pubmed: 10 3 2019
medline: 14 4 2020
Statut: ppublish

Résumé

Rapid influenza diagnostic tests that detect the presence of viral antigens are currently used throughout the United States but have poor sensitivity. The objective of this study was to identify if the use of a new highly accurate rapid point of care test would significantly increase the likelihood of guideline consistent care. We prospectively recruited 300 students at a university health clinic who presented with cough and 1 influenza-like illness symptom between December 2016 and February 2017 to receive care guided by a rapid polymerase chain reaction (PCR) test. Of the 300 patients receiving the PCR test, 264 had complete medical records and were compared to 771 who received usual care. We used a logistic regression model to identify whether PCR guided care was associated with guideline consistent care, based on the appropriate use of oseltamivir and antibiotics. We also assessed whether PCR guided care decreased the likelihood of return visits within 2 weeks by patients. Logistic regression revealed that the odds of receiving guideline supported care did not significantly increase for patients who received PCR guided care (adjusted odds ratio [aOR], 1.24; 95% CI, 0.83-1.88). It significantly decreased the likelihood of an antibiotic prescription (aOR, 0.61; 95% CI, 0.40-0.94), increased the likelihood of receiving oseltamivir (aOR, 1.57; 95% CI, 1.09-2.28), and decreased the likelihood of return visit within 2 weeks (aOR, 0.19; 95% CI, 0.04-0.81). The use of a rapid PCR test did not significantly improve the likelihood of guideline consistent care. However, independent of test outcome, patients who received the test were more likely to receive an antiviral and less likely to receive an antibiotic or have a return visit within 2 weeks.

Sections du résumé

BACKGROUND
Rapid influenza diagnostic tests that detect the presence of viral antigens are currently used throughout the United States but have poor sensitivity. The objective of this study was to identify if the use of a new highly accurate rapid point of care test would significantly increase the likelihood of guideline consistent care.
METHODS
We prospectively recruited 300 students at a university health clinic who presented with cough and 1 influenza-like illness symptom between December 2016 and February 2017 to receive care guided by a rapid polymerase chain reaction (PCR) test. Of the 300 patients receiving the PCR test, 264 had complete medical records and were compared to 771 who received usual care. We used a logistic regression model to identify whether PCR guided care was associated with guideline consistent care, based on the appropriate use of oseltamivir and antibiotics. We also assessed whether PCR guided care decreased the likelihood of return visits within 2 weeks by patients.
RESULTS
Logistic regression revealed that the odds of receiving guideline supported care did not significantly increase for patients who received PCR guided care (adjusted odds ratio [aOR], 1.24; 95% CI, 0.83-1.88). It significantly decreased the likelihood of an antibiotic prescription (aOR, 0.61; 95% CI, 0.40-0.94), increased the likelihood of receiving oseltamivir (aOR, 1.57; 95% CI, 1.09-2.28), and decreased the likelihood of return visit within 2 weeks (aOR, 0.19; 95% CI, 0.04-0.81).
CONCLUSIONS
The use of a rapid PCR test did not significantly improve the likelihood of guideline consistent care. However, independent of test outcome, patients who received the test were more likely to receive an antiviral and less likely to receive an antibiotic or have a return visit within 2 weeks.

Identifiants

DOI: 10.3122/jabfm.2019.02.180183 PMID: 30850459
pubmed: 30850459
pii: 32/2/226
doi: 10.3122/jabfm.2019.02.180183
doi:

Substances chimiques

Anti-Bacterial Agents 0
Antiviral Agents 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

226-233

Commentaires et corrections

Type : CommentIn

Informations de copyright

© Copyright 2019 by the American Board of Family Medicine.

Déclaration de conflit d'intérêts

Conflict of interest: none declared.

Auteurs

Ariella Perry Dale (AP)

From Department of Epidemiology and Biostatistics, University of Georgia, Athens (APD, ME, BM, AH, KD); Center for Ecology of Infectious Diseases, University of Georgia, Athens (AH); University Health Center, University of Georgia, Athens (RF). aperrydale@gmail.com.

Mark Ebell (M)

From Department of Epidemiology and Biostatistics, University of Georgia, Athens (APD, ME, BM, AH, KD); Center for Ecology of Infectious Diseases, University of Georgia, Athens (AH); University Health Center, University of Georgia, Athens (RF).

Brian McKay (B)

From Department of Epidemiology and Biostatistics, University of Georgia, Athens (APD, ME, BM, AH, KD); Center for Ecology of Infectious Diseases, University of Georgia, Athens (AH); University Health Center, University of Georgia, Athens (RF).

Andreas Handel (A)

From Department of Epidemiology and Biostatistics, University of Georgia, Athens (APD, ME, BM, AH, KD); Center for Ecology of Infectious Diseases, University of Georgia, Athens (AH); University Health Center, University of Georgia, Athens (RF).

Ronald Forehand (R)

From Department of Epidemiology and Biostatistics, University of Georgia, Athens (APD, ME, BM, AH, KD); Center for Ecology of Infectious Diseases, University of Georgia, Athens (AH); University Health Center, University of Georgia, Athens (RF).

Kevin Dobbin (K)

From Department of Epidemiology and Biostatistics, University of Georgia, Athens (APD, ME, BM, AH, KD); Center for Ecology of Infectious Diseases, University of Georgia, Athens (AH); University Health Center, University of Georgia, Athens (RF).

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Impact of a Rapid Point of Care Test for...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antiviraux › Impact of a Rapid Point of Care Test for...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Adhésion aux directives › Impact of a Rapid Point of Care Test for...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Impact of a Rapid Point of Care Test for...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Grippe humaine › Impact of a Rapid Point of Care Test for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés non randomisés comme sujet › Impact of a Rapid Point of Care Test for...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Systèmes automatisés lit malade › Analyse sur le lieu d'intervention › Impact of a Rapid Point of Care Test for...
questionsmedicales.fr › Techniques d'investigation › Techniques génétiques › Techniques d'amplification d'acides nucléiques › Réaction de polymérisation en chaîne › Impact of a Rapid Point of Care Test for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Impact of a Rapid Point of Care Test for...