A secondary analysis was conducted of data from 431 patients enrolled into a pragmatic cluster-randomised factorial trial investigating the effect of GP use of C-reactive protein (CRP) point-of-care testing and GP training in enhanced communication skills on antibiotic prescribing for LRTI in general practice in the Netherlands.4,5
GPs made their own decisions about diagnostic procedures and treatment, including whether to prescribe antibiotics or to request a follow-up consultation. GPs were informed that CRP was an additional diagnostic tool to complement findings from medical history taking and physical examination. Extensive information on the training in the use of point-of-care CRP testing and enhanced communication training can be found elsewhere.4,5
Reconsultation data for the 28-day follow-up were obtained from patients' medical records and were cross-checked with patient diary data. Patient-initiated reconsultation was defined as any LRTI-related reconsultation within 28 days after the first consultation, and not specifically requested by the managing GP.
Demographic, clinical, and psychosocial variables possibly associated with patient-initiated reconsultation were predefined by the study team and are shown in . Post-consultation worries were assessed by a Likert-type scale diary question. The association of these variables with patient-initiated reconsultation was assessed with χ2
tests in univariate analysis. Variables with P
-values ≤0.20 were selected for multilevel logistic regression analysis, and odds ratios (OR) with 95% confidence intervals (CIs) are presented. Analyses were by a three-level model to account and correct for variation at the level of the practice, GP, and patient.4
In a second model, CRP categories with measured values at baseline were added to the multiple regression model (available for 227 patients). All models were corrected for the intervention effects, including the interaction term as in the primary analysis.4
Data were analysed using SPSS (version 13.0) and MLwiN (version 2.0).
Factors predicting patient-initiated reconsultation for lower respiratory tract infection within 28 days after initial consultation.
How this fits in
Lower respiratory tract infection accounts for considerable workload in general practice. Reconsultation is common, and may often be unnecessary in that no further treatment is indicated apart from reassurance. Understanding the predictors of reconsultation may help clinicians appropriately modify help-seeking behaviour and could potentially reduce workload through promotion of appropriate self-care. Patient-reported dyspnoea and concerns persisting beyond the initial consultation independently predicted patient-initiated reconsultation. Patients with intermediately elevated levels of C-reactive protein were also more likely to reconsult.