https://doi.org/10.4081/hls.2023.11278
The impact of C-reactive protein testing on treatmentseeking behavior and patients’ attitudes toward their care in Myanmar and Thailand
Submitted: 27 February 2023
Accepted: 24 June 2023
Published: 7 July 2023
Accepted: 24 June 2023
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Supplementary Materials: 26
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Supplementary Materials: 26
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
C-reactive protein (CRP) point-of-care testing can reduce antibiotic prescribing in primary care patients with febrile and respiratory illness, yet little is known about its effects on treatment-seeking behavior. If patients go on to source antibiotics elsewhere, the impact of CRP testing will be limited. A randomized controlled trial assessed the impact of CRP testing on antibiotic prescriptions in Myanmar and Thai primary care patients with a febrile illness. Here we report patients’ treatmentseeking behavior before and during the twoweek study period. Self-reported antibiotic use is compared against urine antibacterial activity. Patients’ opinions towards CRP testing were evaluated. Antibiotic use before study enrolment was reported by 5.4% while antimicrobial activity was detected in 20.8% of samples tested. During the study period, 14.8% of the patients sought additional healthcare, and 4.3% sourced their own antibiotics. Neither were affected by CRP testing. Overall, patients’ satisfaction with their care and CRP testing was high. CRP testing did not affect patients’ treatment-seeking behavior during the study period whilst modestly reducing antibiotic prescriptions. CRP testing appears to be acceptable to patients and their caregivers.
Verbakel JY, Lee JJ, Goyder C, et al. Impact of point-of-care C reactive protein in ambulatory care: a systematic review and meta-analysis. BMJ Open 2019;9:e025036-e36.
DOI: https://doi.org/10.1136/bmjopen-2018-025036
Smedemark SA, Aabenhus R, Llor C, et al. Biomarkers as point-of-care tests to guide the prescription of antibiotics in people with acute respiratory infections in primary care. Cochrane Database Syst Rev 2022;10:Cd010130.
DOI: https://doi.org/10.1002/14651858.CD010130.pub3
Holloway KA, Kotwani A, Batmanabane G, et al. Antibiotic use in South East Asia and policies to promote appropriate use: reports from country situational analyses. BMJ 2017;358:j2291.
DOI: https://doi.org/10.1136/bmj.j2291
Althaus T, Greer RC, Swe MMM, et al. Effect of point-of-care C-reactive protein testing on antibiotic prescription in febrile patients attending primary care in Thailand and Myanmar: an open-label, randomised, controlled trial. Lancet Glob Health 2019;7:e119-e31.
DOI: https://doi.org/10.1016/S2214-109X(18)30444-3
Thai Ministry of Public Health. HDC service report on the service plan for rational drug use 2020. Accessed 17/07/2020 2020. Available from: https://hdcservice.moph.go.th/hdc/reports/report.php?source=pformated/format1.php&cat_id=03b912ab9ccb4c07280a89bf05e5900e&id=d1ccec314e92875acb5142769eb479a2
Murray CJL, Ikuta KS, Sharara F, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022;399:629-55.
DOI: https://doi.org/10.1016/S0140-6736(21)02724-0
Tonkin-Crine S, Anthierens S, Francis NA, et al. Exploring patients’ views of primary care consultations with contrasting interventions for acute cough: a six-country European qualitative study. NPJ Prim Care Respir Med 2014;24:14026.
DOI: https://doi.org/10.1038/npjpcrm.2014.26
Haenssgen MJ, Charoenboon N, Althaus T, et al. The social role of C-reactive protein point-of-care testing to guide antibiotic prescription in Northern Thailand. Soc Sci Med 2018;202:1-12.
DOI: https://doi.org/10.1016/j.socscimed.2018.02.018
Van den Bruel A, Jones C, Thompson M, et al. C-reactive protein point-of-care testing in acutely ill children: a mixed methods study in primary care. Arch Dis Child 2016;101:382.
DOI: https://doi.org/10.1136/archdischild-2015-309228
Do NT, Ta NT, Tran NT, et al. Point-of-care C-reactive protein testing to reduce inappropriate use of antibiotics for non-severe acute respiratory infections in Vietnamese primary health care: a randomised controlled trial. Lancet Glob Health 2016;4:e633-41.
DOI: https://doi.org/10.1016/S2214-109X(16)30142-5
Cals J, Butler C, Hopstaken R, et al. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ 2009;338:1374.
DOI: https://doi.org/10.1136/bmj.b1374
Cals JWL, Schot MJC, de Jong SAM, et al. Point-of-Care C-Reactive Protein Testing and Antibiotic Prescribing for Respiratory Tract Infections: A Randomized Controlled Trial. Ann Fam Med 2010;8:124-33.
DOI: https://doi.org/10.1370/afm.1090
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;382:1175-82.
DOI: https://doi.org/10.1016/S0140-6736(13)60994-0
Schot MJ, Van den Bruel A, Broekhuizen BD, et al. Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial. BJGP Open 2018;2:bjgpopen18X101600-bjgpopen18X00.
DOI: https://doi.org/10.3399/bjgpopen18X101600
Emary KR, Carter MJ, Pol S, et al. Urinary antibiotic activity in paediatric patients attending an outpatient department in north-western Cambodia. Trop Med Int Health 2015;20:24-8.
DOI: https://doi.org/10.1111/tmi.12398
Khennavong M, Davone V, Vongsouvath M, et al. Urine antibiotic activity in patients presenting to hospitals in Laos: implications for worsening antibiotic resistance. Am J Trop Med Hyg 2011;85:295-302.
DOI: https://doi.org/10.4269/ajtmh.2011.11-0076
Liu Y-C, Huang W-K, Huang T-S, et al. Detection of antimicrobial activity in urine for epidemiologic studies of antibiotic use. J Clin Epidemiol 1999;52:539-45.
DOI: https://doi.org/10.1016/S0895-4356(99)00027-X
Greer RC. Evaluation of C-Reactive Protein Point of Care Testing, and Associated Research Challenges, to Improve the Quality of Antibiotic Prescribing in the Community in Northern Thailand. PhD thesis The Open University, 2022.
Andreeva E, Melbye H. Usefulness of C-reactive protein testing in acute cough/respiratory tract infection: an open cluster-randomized clinical trial with C-reactive protein testing in the intervention group. BMC Fam Pract 2014;15:80.
DOI: https://doi.org/10.1186/1471-2296-15-80
Haenssgen MJ, Charoenboon N, Zanello G, et al. Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia. BMJ Open 2019;9:e028224.
DOI: https://doi.org/10.1136/bmjopen-2018-028224
Miyano S, Htoon TT, Nozaki I, et al. Public knowledge, practices, and awareness of antibiotics and antibiotic resistance in Myanmar: The first national mobile phone panel survey. PLoS One 2022;17:e0273380.
DOI: https://doi.org/10.1371/journal.pone.0273380
Liu Y-C, Huang W-K, Huang T-S, et al. Extent of antibiotic use in Taiwan shown by antimicrobial activity in urine. Lancet 1999;354:1360.
DOI: https://doi.org/10.1016/S0140-6736(99)07446-2
Wang H, Wang B, Zhao Q, et al. Antibiotic body burden of Chinese school children: a multisite biomonitoring-based study. Environ Sci Technol 2015;49:5070-9.
DOI: https://doi.org/10.1021/es5059428
How to Cite
Greer, R. C., Althaus, T., Dittrich, S., Butler, C. C., Cheah, P. Y., Wangrangsimakul, T., Smithuis, F. M., Day, N. P., & Lubell, Y. (2023). The impact of C-reactive protein testing on treatmentseeking behavior and patients’ attitudes toward their care in Myanmar and Thailand. Healthcare in Low-Resource Settings, 11(1). https://doi.org/10.4081/hls.2023.11278
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