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目的评估家庭医生使用C反应蛋白(CRP)床边检测和(或)接受增强交流技巧的培训对呼吸道感染患者诊所就诊率及使用抗生素的长期影响。方法此研究对实效、析因、群体-随机对照试验进行了3.5年跟踪;研究选取了荷兰20家家庭医生诊所中因急性咳嗽而就诊的患者,并进行了3.5年的跟踪,最终共379例患者的跟踪数据可用(占试验初始患者的88%)。主要测量结果是跟踪每例患者每年(per patient per year,PPPY)因呼吸道感染看家庭医生的平均次数及使用抗生素的百分比。结果跟踪期间CRP检测组发生呼吸道感染平均次数为0.40 PPPY,非CRP检测组为0.56 PPPY(P=0.12)。医生接受过交流技巧培训组发生呼吸道感染平均次数为0.36 PPPY,未接受过培训组为0.57 PPPY(P=0.09)。跟踪期间CRP检测组因呼吸道感染使用抗生素的比例为30.7%,而在非CRP检测组该比例为35.7%(P=0.36)。医生接受过交流技巧培训组和未接受过培训组因呼吸道感染使用抗生素的比例分别为26.3%和39.1%(P=0.02)。结论家庭医生使用CRP床边检测法和(或)接受加强交流技巧培训对呼吸道感染患者的就诊率影响不大。但在3.5年的跟踪过程中,接受过交流技巧培训的医生在治疗呼吸道感染患者时更少使用抗生素。
Objectives To evaluate the long-term impact of clinic visits and the use of antibiotics for respiratory infections among family doctors using C-reactive protein (CRP) bedside testing and / or training with enhanced communication skills. Methods This study tracked the efficacy, factorial, and population-randomized controlled trials for 3.5 years. The study selected 20 patients from a Dutch family practice clinic for acute cough and performed a follow-up of 3.5 years. A total of 379 patients Patient tracking data was available (88% of patients initially tested). The main measurement is to track the average number of GPs and the percentage of antibiotics used for each patient per year (per patient per year, PPPY) due to respiratory infections. Results The mean frequency of respiratory infections in CRP test was 0.40 PPPY during follow-up, and 0.56 PPPY in non-CRP test (P = 0.12). The average frequency of respiratory infections among physicians trained in communication skills was 0.36 PPPY and that of non-trained subjects was 0.57 PPPY (P = 0.09). The proportion of patients who used antibiotics for CRP during the follow-up period was 30.7% for respiratory infections and 35.7% for non-CRP patients (P = 0.36). The percentage of doctors who used communication skills training and those who did not receive training received antibiotics for respiratory infections were 26.3% and 39.1%, respectively (P = 0.02). Conclusions Family doctor has little effect on the visiting rate of patients with respiratory tract infection by using CRP bedside test and / or training in strengthening communication skills. However, during the 3.5 years of follow-up, doctors trained in communication skills are less likely to use antibiotics for treating patients with respiratory tract infections.