Background

Point-of-care (POC) C-reactive protein (CRP) testing is employed in European primary care settings to differentiate viral from bacterial respiratory tract infections (RTIs) the latter, requiring referral for antibiotics. This service has yet to be trialled in Australian community pharmacy to support over-the-counter RTI management.

Objectives

To evaluate the feasibility, based on clinical and operational outcomes, of POC CRP testing to support Western Australian community pharmacists’ management of RTIs.

Methods

Patients with RTI signs and symptoms were recruited from June–August 2019 at 5 community pharmacies. Trained pharmacists made recommendations based on participants’ POC CRP levels and routine clinical assessment. Participants completed questionnaires and telephone follow-ups on Days 3 (by pharmacists) and 5 (by researchers) post-testing. Service provision and uptake were assessed in 3 separate weekly tally sheets.

Results

Clinical outcomes: CRP levels among the 131 participants recruited were: < 5 mg/L (bacterial infection unlikely; n = 60; 45.8%); 5–19 mg/L (bacterial infection possible if suggestive routine assessment; n = 52; 39.7%) and 20–100 mg/L (bacterial infection likely if suggestive routine assessment; n = 19; 14.5%). Pharmacists’ management included over-the-counter medicines (131, 100%), self-care advice (125, 95.4%) and immediate general practitioner (GP) referral (15, 11.5%). Sixty-five percent (76/117) of participants had recovered by Day 5. Operational outcomes: The services was provided in 21.2% of eligible RTI presentations, representing a service uptake rate of 28.1%. Post-CRP testing, 50.9% (58/114) of participants had changed perceptions regarding their need for antibiotics, with 14.3% (16/112) subsequently intending to seek a GP prescription. Consumer satisfaction was high (100%) and most participants (93.4%, 123/131) would utilise the service again.

Conclusions

POC CRP testing was a feasible and well-accepted strategy to facilitate community pharmacy as a triage point for RTI. Consumer confidence in the pharmacists’ advice, supported by CRP testing, potentially reduced unnecessary GP visits and antibiotic prescribing.

中文翻译：

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支持社区药房呼吸道感染管理的即时 C 反应蛋白检测：一项可行性研究

背景

欧洲初级保健机构采用即时 (POC) C 反应蛋白 (CRP) 检测来区分病毒和细菌性呼吸道感染 (RTI)，后者需要转诊使用抗生素。这项服务尚未在澳大利亚社区药房进行试验，以支持非处方 RTI 管理。

目标

根据临床和操作结果，评估 POC CRP 测试以支持西澳大利亚社区药剂师管理 RTI 的可行性。

方法

从 2019 年 6 月至 8 月，在 5 家社区药房招募了具有 RTI 体征和症状的患者。受过培训的药剂师根据参与者的 POC CRP 水平和常规临床评估提出建议。参与者在测试后的第 3 天（由药剂师）和第 5 天（由研究人员）完成了问卷调查和电话随访。在 3 个单独的每周统计表中评估服务提供和使用情况。

结果

临床结果：招募的 131 名参与者的 CRP 水平为：< 5 mg/L（不太可能发生细菌感染；n = 60；45.8%）；5–19 mg/L（如果提示性常规评估可能存在细菌感染；n = 52；39.7%）和 20–100 mg/L（如果提示性常规评估可能存在细菌感染；n = 19；14.5%）。药剂师的管理包括非处方药 (131, 100%)、自我保健建议 (125, 95.4%) 和直接全科医生 (GP) 转诊 (15, 11.5%)。到第 5 天，65% (76/117) 的参与者已经康复。操作结果：这些服务在 21.2% 的合格 RTI 演示文稿中提供，代表服务接受率为 28.1%。CRP 检测后，50.9% (58/114) 的参与者改变了他们对抗生素需求的看法，14.3% (16/112) 随后打算寻求 GP 处方。消费者满意度很高 (100%)，大多数参与者 (93.4%, 123/131) 会再次使用该服务。

结论

POC CRP 测试是一种可行且广为接受的策略，可促进社区药房作为 RTI 的分类点。在 CRP 测试的支持下，消费者对药剂师建议的信心可能会减少不必要的 GP 就诊和抗生素处方。