Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial

Tjarda M. Boere; Laura W. van Buul; Rogier M. Hopstaken; Ruth B. Veenhuizen; Maurits W. van Tulder; Jochen W. L. Cals; Theo J. M. Verheij; Cees M. P. M. Hertogh

doi:10.1186/s12913-020-5006-0

Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial

Tjarda M. Boere, Laura W. van Buul^*, Rogier M. Hopstaken, Ruth B. Veenhuizen, Maurits W. van Tulder, Jochen W. L. Cals, Theo J. M. Verheij, Cees M. P. M. Hertogh

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background Antibiotics are over-prescribed for lower respiratory tract infections (LRTI) in nursing home residents due to diagnostic uncertainty. Inappropriate antibiotic use is undesirable both on patient level, considering their exposure to side effects and drug interactions, and on societal level, given the development of antibiotic resistance. C-reactive protein (CRP) point-of-care testing (POCT) may be a promising diagnostic tool to reduce antibiotic prescribing for LRTI in nursing homes. The UPCARE study will evaluate whether the use of CRP POCT for suspected LRTI is (cost-) effective in reducing antibiotic prescribing in the nursing home setting. Methods/design A cluster randomized controlled trial will be conducted in eleven nursing homes in the Netherlands, with the nursing home as the unit of randomization. Residents with suspected LRTI who reside at a psychogeriatric, somatic, or geriatric rehabilitation ward are eligible for study participation. Nursing homes in the intervention group will provide care as usual with the possibility to use CRP POCT, and the control group will provide care as usual without CRP POCT for residents with (suspected) LRTI. Data will be collected from September 2018 for approximately 1.5 year, using case report forms that are integrated in the electronic patient record system. The primary study outcome is antibiotic prescribing for suspected LRTI at index consultation (yes/no). Discussion This is the first randomised trial to evaluate the effect of nursing home access to and training in the use of CRP POCT on antibiotic prescribing for LRTI, yielding high-level evidence and contributing to antibiotic stewardship in the nursing home setting. The relatively broad inclusion criteria and the pragmatic study design add to the applicability and generalizability of the study results.

Original language	English
Article number	149
Pages (from-to)	1-8
Number of pages	8
Journal	BMC Health Services Research
Volume	20
Issue number	149
DOIs	https://doi.org/10.1186/s12913-020-5006-0
Publication status	Published - 27 Feb 2020

Keywords

Respiratory tract infection
Nursing home
Antibiotic prescribing
CRP
Point-of-care testing
ACQUIRED PNEUMONIA
BURDEN
FACILITIES
CONSENT

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Boere, T. M., van Buul, L. W., Hopstaken, R. M., Veenhuizen, R. B., van Tulder, M. W., Cals, J. W. L., Verheij, T. J. M., & Hertogh, C. M. P. M. (2020). Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial. BMC Health Services Research, 20(149), 1-8. Article 149. https://doi.org/10.1186/s12913-020-5006-0

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title = "Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial",

abstract = "Background Antibiotics are over-prescribed for lower respiratory tract infections (LRTI) in nursing home residents due to diagnostic uncertainty. Inappropriate antibiotic use is undesirable both on patient level, considering their exposure to side effects and drug interactions, and on societal level, given the development of antibiotic resistance. C-reactive protein (CRP) point-of-care testing (POCT) may be a promising diagnostic tool to reduce antibiotic prescribing for LRTI in nursing homes. The UPCARE study will evaluate whether the use of CRP POCT for suspected LRTI is (cost-) effective in reducing antibiotic prescribing in the nursing home setting. Methods/design A cluster randomized controlled trial will be conducted in eleven nursing homes in the Netherlands, with the nursing home as the unit of randomization. Residents with suspected LRTI who reside at a psychogeriatric, somatic, or geriatric rehabilitation ward are eligible for study participation. Nursing homes in the intervention group will provide care as usual with the possibility to use CRP POCT, and the control group will provide care as usual without CRP POCT for residents with (suspected) LRTI. Data will be collected from September 2018 for approximately 1.5 year, using case report forms that are integrated in the electronic patient record system. The primary study outcome is antibiotic prescribing for suspected LRTI at index consultation (yes/no). Discussion This is the first randomised trial to evaluate the effect of nursing home access to and training in the use of CRP POCT on antibiotic prescribing for LRTI, yielding high-level evidence and contributing to antibiotic stewardship in the nursing home setting. The relatively broad inclusion criteria and the pragmatic study design add to the applicability and generalizability of the study results.",

keywords = "Respiratory tract infection, Nursing home, Antibiotic prescribing, CRP, Point-of-care testing, ACQUIRED PNEUMONIA, BURDEN, FACILITIES, CONSENT",

author = "Boere, {Tjarda M.} and {van Buul}, {Laura W.} and Hopstaken, {Rogier M.} and Veenhuizen, {Ruth B.} and {van Tulder}, {Maurits W.} and Cals, {Jochen W. L.} and Verheij, {Theo J. M.} and Hertogh, {Cees M. P. M.}",

note = "Funding Information: The UPCARE study is funded by The Netherlands Organisation for Health Research and Development (ZonMw, programme Antibiotic Resistance, grant number 541001 004). Orion Diagnostica and Saltro diagnostic center provide in total twenty CRP POCT instruments for the study. The funding bodies have no role in the design of the study, data collection, data analysis, interpretation, nor in writing the manuscript or authority over any of these activities. Publisher Copyright: {\textcopyright} 2020 The Author(s).",

year = "2020",

month = feb,

day = "27",

doi = "10.1186/s12913-020-5006-0",

language = "English",

volume = "20",

pages = "1--8",

journal = "BMC Health Services Research",

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publisher = "BioMed Central Ltd",

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Boere, TM, van Buul, LW, Hopstaken, RM, Veenhuizen, RB, van Tulder, MW, Cals, JWL, Verheij, TJM & Hertogh, CMPM 2020, 'Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial', BMC Health Services Research, vol. 20, no. 149, 149, pp. 1-8. https://doi.org/10.1186/s12913-020-5006-0

Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial. / Boere, Tjarda M.; van Buul, Laura W.; Hopstaken, Rogier M. et al.
In: BMC Health Services Research, Vol. 20, No. 149, 149, 27.02.2020, p. 1-8.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE)

T2 - study design of a cluster randomized controlled trial

AU - Boere, Tjarda M.

AU - van Buul, Laura W.

AU - Hopstaken, Rogier M.

AU - Veenhuizen, Ruth B.

AU - van Tulder, Maurits W.

AU - Cals, Jochen W. L.

AU - Verheij, Theo J. M.

AU - Hertogh, Cees M. P. M.

N1 - Funding Information: The UPCARE study is funded by The Netherlands Organisation for Health Research and Development (ZonMw, programme Antibiotic Resistance, grant number 541001 004). Orion Diagnostica and Saltro diagnostic center provide in total twenty CRP POCT instruments for the study. The funding bodies have no role in the design of the study, data collection, data analysis, interpretation, nor in writing the manuscript or authority over any of these activities. Publisher Copyright: © 2020 The Author(s).

PY - 2020/2/27

Y1 - 2020/2/27

N2 - Background Antibiotics are over-prescribed for lower respiratory tract infections (LRTI) in nursing home residents due to diagnostic uncertainty. Inappropriate antibiotic use is undesirable both on patient level, considering their exposure to side effects and drug interactions, and on societal level, given the development of antibiotic resistance. C-reactive protein (CRP) point-of-care testing (POCT) may be a promising diagnostic tool to reduce antibiotic prescribing for LRTI in nursing homes. The UPCARE study will evaluate whether the use of CRP POCT for suspected LRTI is (cost-) effective in reducing antibiotic prescribing in the nursing home setting. Methods/design A cluster randomized controlled trial will be conducted in eleven nursing homes in the Netherlands, with the nursing home as the unit of randomization. Residents with suspected LRTI who reside at a psychogeriatric, somatic, or geriatric rehabilitation ward are eligible for study participation. Nursing homes in the intervention group will provide care as usual with the possibility to use CRP POCT, and the control group will provide care as usual without CRP POCT for residents with (suspected) LRTI. Data will be collected from September 2018 for approximately 1.5 year, using case report forms that are integrated in the electronic patient record system. The primary study outcome is antibiotic prescribing for suspected LRTI at index consultation (yes/no). Discussion This is the first randomised trial to evaluate the effect of nursing home access to and training in the use of CRP POCT on antibiotic prescribing for LRTI, yielding high-level evidence and contributing to antibiotic stewardship in the nursing home setting. The relatively broad inclusion criteria and the pragmatic study design add to the applicability and generalizability of the study results.

AB - Background Antibiotics are over-prescribed for lower respiratory tract infections (LRTI) in nursing home residents due to diagnostic uncertainty. Inappropriate antibiotic use is undesirable both on patient level, considering their exposure to side effects and drug interactions, and on societal level, given the development of antibiotic resistance. C-reactive protein (CRP) point-of-care testing (POCT) may be a promising diagnostic tool to reduce antibiotic prescribing for LRTI in nursing homes. The UPCARE study will evaluate whether the use of CRP POCT for suspected LRTI is (cost-) effective in reducing antibiotic prescribing in the nursing home setting. Methods/design A cluster randomized controlled trial will be conducted in eleven nursing homes in the Netherlands, with the nursing home as the unit of randomization. Residents with suspected LRTI who reside at a psychogeriatric, somatic, or geriatric rehabilitation ward are eligible for study participation. Nursing homes in the intervention group will provide care as usual with the possibility to use CRP POCT, and the control group will provide care as usual without CRP POCT for residents with (suspected) LRTI. Data will be collected from September 2018 for approximately 1.5 year, using case report forms that are integrated in the electronic patient record system. The primary study outcome is antibiotic prescribing for suspected LRTI at index consultation (yes/no). Discussion This is the first randomised trial to evaluate the effect of nursing home access to and training in the use of CRP POCT on antibiotic prescribing for LRTI, yielding high-level evidence and contributing to antibiotic stewardship in the nursing home setting. The relatively broad inclusion criteria and the pragmatic study design add to the applicability and generalizability of the study results.

KW - Respiratory tract infection

KW - Nursing home

KW - Antibiotic prescribing

KW - CRP

KW - Point-of-care testing

KW - ACQUIRED PNEUMONIA

KW - BURDEN

KW - FACILITIES

KW - CONSENT

U2 - 10.1186/s12913-020-5006-0

DO - 10.1186/s12913-020-5006-0

M3 - Article

C2 - 32103747

SN - 1472-6963

VL - 20

SP - 1

EP - 8

JO - BMC Health Services Research

JF - BMC Health Services Research

IS - 149

M1 - 149

ER -

Boere TM, van Buul LW, Hopstaken RM, Veenhuizen RB, van Tulder MW, Cals JWL et al. Using point-of-care C-reactive protein to guide antibiotic prescribing for lower respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial. BMC Health Services Research. 2020 Feb 27;20(149):1-8. 149. doi: 10.1186/s12913-020-5006-0