The Health Information and Quality Authority (HIQA) has commenced a national public consultation on a Draft Health Technology Assessment of C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing for acute respiratory tract infections in primary care settings.



Antimicrobial resistance occurs when bacteria adapt in response to the use of medicines. When bacteria become antibiotic resistant, infections become more difficult to manage and treat. Antimicrobial resistance is a significant threat to public health, and widely acknowledged to be associated with the excessive and inappropriate consumption of antibiotics. Most antibiotics are prescribed in primary care settings and frequently to treat respiratory tract infections, which account for approximately one quarter of primary care attendances.



The objective of CRP POCT is to assist the clinician rule out serious bacterial infection, thereby supporting a decision not to prescribe an antibiotic to those who are unlikely to benefit from treatment. HIQA’s health technology assessment reviews the clinical and cost-effectiveness of CRP POCT. The assessment will inform a decision as to whether CRP POCT should be used to support antibiotic prescribing in primary care for patients presenting with symptoms of acute respiratory tract infection. The assessment also considers the organisational implications associated with introducing CRP POCT in primary care.



HIQA’s Chief Scientist, Dr Conor Teljeur, said: “In European terms, Ireland has a moderate to high rate of antibiotic prescribing. A large proportion of those prescriptions are initiated in primary care for patients with acute respiratory infections. Most respiratory tract infections are self-limiting and caused by viruses. Antibiotics are only useful for patients with bacterial infections. It is not always clear if a patient presenting with a respiratory tract infection has a bacterial or viral infection. C-reactive protein point-of-care testing can support a GP in deciding not to prescribe an antibiotic. In clinical trials C-reactive protein point-of-care testing in primary care has been shown to be effective in reducing antibiotic prescribing without affecting patient safety.”



The review concluded that the use of CRP POCT to inform antibiotic prescribing in primary care for acute respiratory tract infections leads to a significant reduction in antibiotic prescribing without compromising patient safety. While there is evidence that CRP POCT has a short-term effect on antibiotic prescribing, it is unclear whether that effect is sustained over the longer term. The draft findings of HIQA’s report have been published for public consultation.



Dr Teljeur continued: “Antimicrobial resistance is an increasing problem and a range of initiatives are in place to tackle it. By reducing antibiotic prescribing, CRP POCT has the potential to ensure that antibiotics are reserved for those with the greatest potential to benefit from treatment, minimising exposure to adverse events, and contributing to reduced antimicrobial resistance both for individual patients and for the wider community.”

HIQA invites members of the public to give feedback on the draft report until Friday, 15 March 2019.



You can read the draft report and take part in the public consultation from this link

Ends.



For further information please contact:

Marty Whelan, Head of Communications and Stakeholder Engagement

01 814 7480 / 086 244 7623 / mwhelan@hiqa.ie

Notes to the Editor:

• HIQA is the statutory organisation in Ireland with responsibility to carry out national health technology assessments (HTAs) and to develop guidelines for the conduct of HTAs across our healthcare system.
• HIQA has a statutory remit to evaluate the clinical and cost-effectiveness of health technologies, providing advice to the Minister for Health and to the Health Service Executive (HSE).
• Antibiotics target bacteria and are not effective against viruses. Antibiotic-related adverse events are common. The majority of acute respiratory tract infections are self-limiting; most are viral in origin. The need for an antibiotic should therefore be considered in the context of the potential to benefit from treatment relative to the potential to be harmed.
• Antimicrobial resistance leads to the deaths of approximately 700,000 people globally each year. Studies have shown that increased antibiotic consumption correlates with increased antibiotic resistance, which gives rise to increased morbidity and mortality from bacterial infections and increased economic burden on the healthcare sector.
• A CRP test result is based on a measure of the C-reactive protein levels in a blood sample. CRP is an acute-phase protein produced in response to infection or tissue inflammation. Raised concentrations of CRP often occur in bacterial infections, while typically only minor elevations are observed in viral infections.
• Ireland has a high rate of antibiotic prescribing in patients presenting to primary care with acute respiratory tract infections: an estimated 2.4 million prescriptions are issued for respiratory tract infections in Ireland each year – that number could fall to 1.2 million if GPs used CRP POCT and were provided with supports to facilitate conversations with their patients about appropriate antibiotic prescribing.
• Clinical trials have demonstrated that the use of CRP POCT in primary care settings to inform antibiotic prescribing for acute respiratory tract infections leads to a significant reduction in antibiotic prescribing without compromising patient safety.
• The clinical effectiveness of CRP POCT is not clearly explained by the results of the analysis of diagnostic test accuracy. It is likely that the impact of CRP POCT is related to how it facilitates communication between the clinician and the patient.
• Participating in an external quality assurance scheme more than once, performing internal quality control at least weekly, the type of instrument used, having laboratory-qualified personnel performing the tests, and performing more than 10 CRP tests per week were all associated with good test performance.