On 2015 Sep 08, CREBP Journal Club commented:

This study gives an excellent insight into GPs’ experiences of two contrasting interventions – training in communication skills (including use of a patient booklet) and the use of a point of care test (CRP). We found it encouraging that the clinicians reported gaining new knowledge from the interventions. Information, such as expected duration of illness and the benefits and harms of antibiotic treatment of acute respiratory infections should preferably be part of any intervention aimed at either GPs or patients. Both interventions achieved important reductions in antibiotic prescribing for acute respiratory infections – and combining the interventions was associated with an even greater reduction(1). The group discussed if future interventions should be multi-faceted. Anthierens et al. found that the GPs reported that the two interventions were complementary and often used for different situations, i.e. the CRP test when there was uncertainty about the severity of the infection, and the communication skills/booklet when an explanation was required. However, it was mentioned that in some countries, such as Australia, the CRP test is still not routinely used as a point of care test in general practice. The group found the information in the booklet very useful. However, the sections about “Helping your immune system fight infection” and “How you can care for your cough” were debated. E.g. a Cochrane Review on Echinacea products did not find any benefits for treating colds(2) and also in the booklet it is stated that the advice on fluids, rest and stress is based on evidence about how the immune system works. Preferably, information used in interventions to enhance the quality of antibiotic prescribing for acute respiratory infections should be based on solid evidence about the group of patients being examined – i.e. in this case patients with acute respiratory infections. In addition, high quality, primary care-based studies are needed to further explore alternatives such as probiotics, zinc and vitamin C and to develop and test new non-antibiotic treatments. See CREBP Journal Club for more information.

References: (1) Little P, Stuart B, Francis N, et al. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet 2013; 382(9899): 1175-82. (2) Karsch-Volk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. The Cochrane database of systematic reviews 2014; 2: Cd000530.

On 2015 Sep 08, CREBP Journal Club commented:

This study gives an excellent insight into GPs’ experiences of two contrasting interventions – training in communication skills (including use of a patient booklet) and the use of a point of care test (CRP). We found it encouraging that the clinicians reported gaining new knowledge from the interventions. Information, such as expected duration of illness and the benefits and harms of antibiotic treatment of acute respiratory infections should preferably be part of any intervention aimed at either GPs or patients. Both interventions achieved important reductions in antibiotic prescribing for acute respiratory infections – and combining the interventions was associated with an even greater reduction(1). The group discussed if future interventions should be multi-faceted. Anthierens et al. found that the GPs reported that the two interventions were complementary and often used for different situations, i.e. the CRP test when there was uncertainty about the severity of the infection, and the communication skills/booklet when an explanation was required. However, it was mentioned that in some countries, such as Australia, the CRP test is still not routinely used as a point of care test in general practice. The group found the information in the booklet very useful. However, the sections about “Helping your immune system fight infection” and “How you can care for your cough” were debated. E.g. a Cochrane Review on Echinacea products did not find any benefits for treating colds(2) and also in the booklet it is stated that the advice on fluids, rest and stress is based on evidence about how the immune system works. Preferably, information used in interventions to enhance the quality of antibiotic prescribing for acute respiratory infections should be based on solid evidence about the group of patients being examined – i.e. in this case patients with acute respiratory infections. In addition, high quality, primary care-based studies are needed to further explore alternatives such as probiotics, zinc and vitamin C and to develop and test new non-antibiotic treatments. See CREBP Journal Club for more information.

References: (1) Little P, Stuart B, Francis N, et al. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet 2013; 382(9899): 1175-82. (2) Karsch-Volk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. The Cochrane database of systematic reviews 2014; 2: Cd000530.