Respiratory Tract Diseases
Conditions
Brief summary
The project is a pragmatic approach to primary care. The main objective is to evaluate the impact of making a CRP measurement device available in primary care general practices on antibiotic prescribing for upper respiratory tract (URT) or lower respiratory tract (LRT) infections.
Interventions
DIAGNOSTIC_TESTQuick test
The 70 GPs in the intervention arm will be able to measure CRP levels by using the Quick read GO in patients with upper or lower respiratory tract infections
Sponsors
MSPU des 3 Provinces
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Patients who have received information and given written consent * Patients of any age consulting a general practice with one or more of the following symptoms: fever, cough, arthralgias, myalgias, rhinorrhea; * Symptomatology evolving for more than 24 hours; * Symptoms associated with an upper respiratory tract infection such as otitis, angina, laryngitis, rhinopharyngitis, sinusitis; and/or a lower respiratory tract infection such as acute bronchitis, pneumonia, exacerbation of COPD (chronic obstructive pulmonary disease).
Exclusion criteria
These criteria correspond to factors making interpretation of the CRP value difficult: * Antibiotics taken in the 15 days prior to inclusion * Presence of one of the following signs of severity requiring immediate hospitalization: Impairment of higher functions (altered consciousness) Sign of severity (Pas\<90mmHg; HR\>120/min; FR\>30 cycles/min) Temperature \<35 or \>40°c Inhalation pneumonitis * Sepsis: organ dysfunction, FR\>22cycles/min, PAS≤100 mmHg and Galsgow score ≤ 13(34) * Immediate hospitalization * Pregnancy * Burns * Heat stroke * Presenting with an associated serious pathology: * Associated neoplastic disease in progress * Severe liver failure * Ischemic or thromboembolic pathology * Traumatic pathology * Inflammatory rheumatism * Autoimmune disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Antibiotic dispensing rate | through study completion, an average of 1 year | This calculated index is defined by the French health insurance scheme as the "number of antibiotic treatments per 100 patients aged 16 to 65 / attending physician". It is expressed as a percentage. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| antibiotics prescriptions in other unit of measure | through study completion, an average of 1 year | defined daily doses delivered per 1000 patients in both groups (doctors with or whitout TROD) |
| Factors influencing the modulation of antibiotic dispensing | baseline and one year | factors may be influence the modulation of antibiotic dispensing: * age of physician in year (age group or average age) * physician gender, qualitative data (number of male gender or number of femal gender) * practitioner training supervisor or not, qualitative date "yes" or "not" * physician geographical location, qualitative data (rural or urban) * type of exercice, qualitative data (medical center or single exercice) * seasonal effect, comparison of various parameters according to the winter or summer period * volume of patients followed by years (number of patients treated by the general practitioner by year) * type of patients followed : number of patients with or without long-term illness followed by the GP, age (years) of patients followed by the GP, gender of patients (in number or percentage) followed by the GP |
| Evolution of antibiotic dispensing in the daily delivered dose in both GP's groups (doctors with and without TROD) | baseline and 3 months, baseline and 6 months, baseline and 1 year, between winter and summer period | temporal variability in the daily delivered dose of antibiotics prescriptions in both GP's groups (doctors with and without TROD) |
| Complementary radiological and biological examinations | one year | * number of chest X-rays prescribed in both groups (doctors with and without TROD) * number of biological examinations (blood counts, CRP, ferritinemia, firinogen, urine cytobacteriological examination) prescribed in both groups (doctors with and without TROD); |
Countries
France
Outcome results
None listed