Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial
Abstract Background Antibiotics are over-prescribed for lower respiratory tract infections (LRTI) in nursing home residents due to diagnostic uncertainty. Inappropriate antibiotic use is undesirable both on patient level, considering their exposure to side effects and drug interactions, and on socie...
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doaj-7fb70f475f88424b827f69c4de9610532020-11-25T02:11:43ZengBMCBMC Health Services Research1472-69632020-02-012011810.1186/s12913-020-5006-0Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trialTjarda M. Boere0Laura W. van Buul1Rogier M. Hopstaken2Ruth B. Veenhuizen3Maurits W. van Tulder4Jochen W. L. Cals5Theo J. M. Verheij6Cees M. P. M. Hertogh7Department of General Practice & Old Age Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, location VU University Medical CenterDepartment of General Practice & Old Age Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, location VU University Medical CenterStar-SHL diagnostic centersDepartment of General Practice & Old Age Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, location VU University Medical CenterDepartment of Health Sciences, VU UniversityDepartment of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht UniversityNational lnstitute for Public Health and the Environment (RlVM)Department of General Practice & Old Age Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, location VU University Medical CenterAbstract Background Antibiotics are over-prescribed for lower respiratory tract infections (LRTI) in nursing home residents due to diagnostic uncertainty. Inappropriate antibiotic use is undesirable both on patient level, considering their exposure to side effects and drug interactions, and on societal level, given the development of antibiotic resistance. C-reactive protein (CRP) point-of-care testing (POCT) may be a promising diagnostic tool to reduce antibiotic prescribing for LRTI in nursing homes. The UPCARE study will evaluate whether the use of CRP POCT for suspected LRTI is (cost-) effective in reducing antibiotic prescribing in the nursing home setting. Methods/design A cluster randomized controlled trial will be conducted in eleven nursing homes in the Netherlands, with the nursing home as the unit of randomization. Residents with suspected LRTI who reside at a psychogeriatric, somatic, or geriatric rehabilitation ward are eligible for study participation. Nursing homes in the intervention group will provide care as usual with the possibility to use CRP POCT, and the control group will provide care as usual without CRP POCT for residents with (suspected) LRTI. Data will be collected from September 2018 for approximately 1.5 year, using case report forms that are integrated in the electronic patient record system. The primary study outcome is antibiotic prescribing for suspected LRTI at index consultation (yes/no). Discussion This is the first randomised trial to evaluate the effect of nursing home access to and training in the use of CRP POCT on antibiotic prescribing for LRTI, yielding high-level evidence and contributing to antibiotic stewardship in the nursing home setting. The relatively broad inclusion criteria and the pragmatic study design add to the applicability and generalizability of the study results. Trial registration Netherlands Trial Register, Trial NL5054. Registered 29 August 2018.http://link.springer.com/article/10.1186/s12913-020-5006-0Respiratory tract infectionNursing homeAntibiotic prescribingCRPPoint-of-care testing |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Tjarda M. Boere Laura W. van Buul Rogier M. Hopstaken Ruth B. Veenhuizen Maurits W. van Tulder Jochen W. L. Cals Theo J. M. Verheij Cees M. P. M. Hertogh |
spellingShingle |
Tjarda M. Boere Laura W. van Buul Rogier M. Hopstaken Ruth B. Veenhuizen Maurits W. van Tulder Jochen W. L. Cals Theo J. M. Verheij Cees M. P. M. Hertogh Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial BMC Health Services Research Respiratory tract infection Nursing home Antibiotic prescribing CRP Point-of-care testing |
author_facet |
Tjarda M. Boere Laura W. van Buul Rogier M. Hopstaken Ruth B. Veenhuizen Maurits W. van Tulder Jochen W. L. Cals Theo J. M. Verheij Cees M. P. M. Hertogh |
author_sort |
Tjarda M. Boere |
title |
Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial |
title_short |
Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial |
title_full |
Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial |
title_fullStr |
Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial |
title_full_unstemmed |
Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial |
title_sort |
using point-of-care c-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (upcare): study design of a cluster randomized controlled trial |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2020-02-01 |
description |
Abstract Background Antibiotics are over-prescribed for lower respiratory tract infections (LRTI) in nursing home residents due to diagnostic uncertainty. Inappropriate antibiotic use is undesirable both on patient level, considering their exposure to side effects and drug interactions, and on societal level, given the development of antibiotic resistance. C-reactive protein (CRP) point-of-care testing (POCT) may be a promising diagnostic tool to reduce antibiotic prescribing for LRTI in nursing homes. The UPCARE study will evaluate whether the use of CRP POCT for suspected LRTI is (cost-) effective in reducing antibiotic prescribing in the nursing home setting. Methods/design A cluster randomized controlled trial will be conducted in eleven nursing homes in the Netherlands, with the nursing home as the unit of randomization. Residents with suspected LRTI who reside at a psychogeriatric, somatic, or geriatric rehabilitation ward are eligible for study participation. Nursing homes in the intervention group will provide care as usual with the possibility to use CRP POCT, and the control group will provide care as usual without CRP POCT for residents with (suspected) LRTI. Data will be collected from September 2018 for approximately 1.5 year, using case report forms that are integrated in the electronic patient record system. The primary study outcome is antibiotic prescribing for suspected LRTI at index consultation (yes/no). Discussion This is the first randomised trial to evaluate the effect of nursing home access to and training in the use of CRP POCT on antibiotic prescribing for LRTI, yielding high-level evidence and contributing to antibiotic stewardship in the nursing home setting. The relatively broad inclusion criteria and the pragmatic study design add to the applicability and generalizability of the study results. Trial registration Netherlands Trial Register, Trial NL5054. Registered 29 August 2018. |
topic |
Respiratory tract infection Nursing home Antibiotic prescribing CRP Point-of-care testing |
url |
http://link.springer.com/article/10.1186/s12913-020-5006-0 |
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