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Use of point-of-care tests in pharyngotonsillitis–a registry-based study in primary health care

Pallon, Jon LU and Hedin, Katarina LU (2024) In Scandinavian Journal of Primary Health Care
Abstract

Background: Point-of-care (POC) tests, including C-reactive protein (CRP) tests and rapid antigen detection tests (RADT) for group A streptococci (GAS), are widely used in Swedish primary health care (PHC). This study quantifies their use in pharyngotonsillitis and explore their association with antibiotic prescribing. Material and methods: Retrospective data from 2012–2016 in Region Kronoberg, Sweden, included all PHC visits with a pharyngotonsillitis diagnosis. Patient characteristics, test usage and antibiotic prescriptions were linked by visit date and personal identification number. Descriptive statistics were used for POC test analysis. Logistic regression assessed the association between CRP levels and antibiotic prescribing.... (More)

Background: Point-of-care (POC) tests, including C-reactive protein (CRP) tests and rapid antigen detection tests (RADT) for group A streptococci (GAS), are widely used in Swedish primary health care (PHC). This study quantifies their use in pharyngotonsillitis and explore their association with antibiotic prescribing. Material and methods: Retrospective data from 2012–2016 in Region Kronoberg, Sweden, included all PHC visits with a pharyngotonsillitis diagnosis. Patient characteristics, test usage and antibiotic prescriptions were linked by visit date and personal identification number. Descriptive statistics were used for POC test analysis. Logistic regression assessed the association between CRP levels and antibiotic prescribing. Results: Of 24,237 visits, 68% included RADT and 36% included a CRP test, with 89% of CRP tests performed alongside RADT. CRP testing was more frequent in patients with negative (56%) than positive RADTs (42%) (p <.001). Overall, 66% of RADTs were positive. Median CRP levels were 23 mg/l for positive RADT and 31 mg/l for negative RADT (p <.001). Antibiotics were prescribed for 95% of positive RADTs and 43% of negative RADTs (p <.001). In patients with negative RADTs, CRP testing was associated with higher antibiotic prescribing (57%) compared to no CRP testing (26%) (p <.001). Among these patients, CRP levels were associated with prescribing (aOR 1.032; 95% CI 1.029–1.035; p <.001), with 50% of prescriptions occuring at CRP levels ≤ 20 mg/l. Conclusion: The use of RADTs and the proportion of positive test were higher than expected, indicating inappropriate use and diagnostic bias. CRP testing, contrary to guidelines, was common and associated with increased antibiotic prescribing.

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author
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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
antibiotic prescribing, C-reactive protein, Pharyngotonsillitis, point-of-care tests, primary health care, rapid antigen detection test
in
Scandinavian Journal of Primary Health Care
publisher
Informa Healthcare
external identifiers
  • pmid:39460385
  • scopus:85207964478
ISSN
0281-3432
DOI
10.1080/02813432.2024.2416671
language
English
LU publication?
yes
id
82328c91-384f-4ccc-8ae3-b152441256ad
date added to LUP
2024-12-16 14:35:26
date last changed
2025-07-01 17:52:34
@article{82328c91-384f-4ccc-8ae3-b152441256ad,
  abstract     = {{<p>Background: Point-of-care (POC) tests, including C-reactive protein (CRP) tests and rapid antigen detection tests (RADT) for group A streptococci (GAS), are widely used in Swedish primary health care (PHC). This study quantifies their use in pharyngotonsillitis and explore their association with antibiotic prescribing. Material and methods: Retrospective data from 2012–2016 in Region Kronoberg, Sweden, included all PHC visits with a pharyngotonsillitis diagnosis. Patient characteristics, test usage and antibiotic prescriptions were linked by visit date and personal identification number. Descriptive statistics were used for POC test analysis. Logistic regression assessed the association between CRP levels and antibiotic prescribing. Results: Of 24,237 visits, 68% included RADT and 36% included a CRP test, with 89% of CRP tests performed alongside RADT. CRP testing was more frequent in patients with negative (56%) than positive RADTs (42%) (p &lt;.001). Overall, 66% of RADTs were positive. Median CRP levels were 23 mg/l for positive RADT and 31 mg/l for negative RADT (p &lt;.001). Antibiotics were prescribed for 95% of positive RADTs and 43% of negative RADTs (p &lt;.001). In patients with negative RADTs, CRP testing was associated with higher antibiotic prescribing (57%) compared to no CRP testing (26%) (p &lt;.001). Among these patients, CRP levels were associated with prescribing (aOR 1.032; 95% CI 1.029–1.035; p &lt;.001), with 50% of prescriptions occuring at CRP levels ≤ 20 mg/l. Conclusion: The use of RADTs and the proportion of positive test were higher than expected, indicating inappropriate use and diagnostic bias. CRP testing, contrary to guidelines, was common and associated with increased antibiotic prescribing.</p>}},
  author       = {{Pallon, Jon and Hedin, Katarina}},
  issn         = {{0281-3432}},
  keywords     = {{antibiotic prescribing; C-reactive protein; Pharyngotonsillitis; point-of-care tests; primary health care; rapid antigen detection test}},
  language     = {{eng}},
  publisher    = {{Informa Healthcare}},
  series       = {{Scandinavian Journal of Primary Health Care}},
  title        = {{Use of point-of-care tests in pharyngotonsillitis–a registry-based study in primary health care}},
  url          = {{http://dx.doi.org/10.1080/02813432.2024.2416671}},
  doi          = {{10.1080/02813432.2024.2416671}},
  year         = {{2024}},
}