Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care

Moberg, Anna; Cronberg, Olof; Falk, Magnus; Hedin, Katarina

doi:10.3399/bjgpopen20x101015

Cited by 9 publications

(9 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, not only Danish GPs seem to use the CRP test frequently. A Swedish study has also found an increased use of CRP testing for patients with symptoms of an acute LRTI from 55% in 2006 to 62% in 2014 [21].…”

Section: Discussion Of Findingsmentioning

confidence: 99%

Danish GPs’ Experiences When Managing Patients Presenting to General Practice with Symptoms of Acute Lower Respiratory Tract Infections: A Qualitative Study

et al. 2021

View full text Add to dashboard Cite

One of the most common indications for antibiotic prescribing in general practice is acute lower respiratory tract infections (LRTI). This study aimed to explore general practitioners’ (GPs’) considerations and experiences when managing patients with symptoms of an acute LRTI. Individual semi-structured interviews were conducted with seven GPs in the North Denmark Region from January to March 2020. Data were analysed by means of systematic text condensation. The analysis revealed four themes: (1) practicalities of assessing patients with LRTI, (2) assessment of the patient, (3) treatment decisions, and (4) patient expectations. The GPs described having developed individual diagnostic strategies and routines when managing patients with symptoms of an acute LRTI. However, a general assessment of the patient was essential to all the GPs and the diagnosis was seldom based on a single symptom or finding. Most GPs described having great faith in abnormal lung auscultation. The use of C-reactive protein testing served several purposes, such as deciding on the severity of the infection, prescribing antibiotics or not, and as a communicative tool. Diagnostic uncertainty is a driver of antibiotic use and clinical practice might benefit from the development of clinical prediction rules for diagnosing pneumonia.

show abstract

Section: Discussion Of Findingsmentioning

confidence: 99%

Danish GPs’ Experiences When Managing Patients Presenting to General Practice with Symptoms of Acute Lower Respiratory Tract Infections: A Qualitative Study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…This may explain why it was used more often for patients with longer symptom duration. The proportion of CXRs was high in the control group as compared to a recent Swedish register-based study where CXR was shown to be used in 12% of patients with pneumonia in primary care [28].…”

Section: Findings In Relation To Other Studiesmentioning

confidence: 53%

Use of chest X-ray in the assessment of community acquired pneumonia in primary care – an intervention study

Moberg

Kling

Paues

et al. 2020

Scandinavian Journal of Primary Health Care

Self Cite

View full text Add to dashboard Cite

Objectives: The aim of this study was to explore if consequent use of chest X-ray (CXR), when the physician is not sure of the diagnosis of pneumonia after clinical examination and CRP-testing, favors a more restrictive prescribing of antibiotics. Design: This was an intervention study conducted between September 2015 and December 2017. Setting: Two intervention primary health care centers (PHCCs) and three control PHCCs in the southeast of Sweden. Intervention: All patients were referred for CXR when the physicians suspicion of pneumonia was 'unsure', or 'quite sure' after CRP-testing. Control units managed patients according to their usual routine after clinical examination and CRP-testing. Subjects: A total of 104 patients were included in the intervention group and 81 patients in the control group. The inclusion criteria of the study were clinically suspected pneumonia in patients !18 years, with respiratory symptoms for more than 24 h. Main outcome measure: Antibiotic prescribing rate. Results: In the intervention group, 85% were referred for CXR and 69% were prescribed antibiotics, as compared to 26% and 77% in the control group. The difference in antibiotic prescribing rate was not statistically significant, unadjusted OR 0.68 [0.35-1.3] and adjusted OR 1.1 [CI 0.43-3.0]. A total of 24% of patients with negative CXR were prescribed antibiotics. Conclusion: This study could not prove that use of CXR when the physician was not sure of the diagnosis of pneumonia results in lowered antibiotic prescribing rate in primary care. In cases of negative findings on CXR the physicians do not seem to rely on the outcome when it comes to antibiotic prescribing. KEY POINTS Routine use of chest X-ray when the clinical diagnosis of pneumonia is uncertain has not been proven to result in lowered antibiotic prescribing rate. Physicians do not fully rely on chest X-ray outcome and to some extent prescribe antibiotics even if negative, when community-acquired pneumonia is suspected. Chest X-ray is already used in one out of four cases in routine primary care of pneumonia patients in Sweden.

show abstract

“…It was quite surprising that the use of CXR differed so much (5% vs. 88%). The low use of CXR in primary care contrasts with previous studies indicating a usage of 12–22% in cases of suspected pneumonia; however, the methodologies and study populations differ [ 19 , 20 ]. The finding suggests that emergency care routinely uses CXR when pneumonia is suspected.…”

Section: Discussionmentioning

confidence: 65%

Management and documentation of pneumonia – a comparison of patients consulting primary care and emergency care

Arntsberg,

Fernberg,

Berger

et al. 2024

Scandinavian Journal of Primary Health Care

Self Cite

View full text Add to dashboard Cite

Patients may attend either primary or emergency care without referral in Sweden. Guidelines recommend a severity assessment, including assessment of vital signs, to be performed for all patients presenting with suspected pneumonia. Objective To compare management and documentation of vital signs, symptoms and infection severity in pneumonia patients seeking primary care and emergency care without referral. Design Medical record review of vital signs, examination findings and severity of pneumonia. Setting Primary and emergency care. Subjects Two hundred and forty patients diagnosed with pneumonia. Main outcome measures Vital signs, examination findings and severity of pneumonia. Assessments of pneumonia severity according to the reviewers, the traffic light score and CRB-65. Results Respiratory rate, blood pressure, heart rate and oxygen saturation were less often documented in primary care ( p < .001). Chest X-ray was performed in 5% of primary care patients vs. 88% of emergency care patients ( p < .01). Primary care patients had longer symptom duration, higher oxygen saturation and lower respiratory rate. In total, the reviewers assessed 63% of all pneumonias as mild and 9% as severe. The traffic light scoring model identified 11 patients (9%) in primary care and 53 patients (44%) in emergency care at high risk of severe infection. Conclusions Vital signs were documented less often in primary care than in emergency care. Patients in primary care appear to have a less severe pneumonia, indicating attendance to the correct care level. The traffic light scoring model identified more patients at risk of severe infection than CRB-65, where the parameters were documented to a limited extent.

show abstract

Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care

Cited by 9 publications

References 24 publications

Danish GPs’ Experiences When Managing Patients Presenting to General Practice with Symptoms of Acute Lower Respiratory Tract Infections: A Qualitative Study

Danish GPs’ Experiences When Managing Patients Presenting to General Practice with Symptoms of Acute Lower Respiratory Tract Infections: A Qualitative Study

Use of chest X-ray in the assessment of community acquired pneumonia in primary care – an intervention study

Management and documentation of pneumonia – a comparison of patients consulting primary care and emergency care

Contact Info

Product

Resources

About