Testing for resistance: Point-of-care testing as a communicational tool in antibiotic prescribing
DOI:
https://doi.org/10.1558/cam.32191Keywords:
antibiotics, conversation analysis, elevated results, normal results, point-of-care test, primary careAbstract
As antibiotic resistance becomes a growing health emergency, effective strategies are needed to reduce inappropriate antibiotic use. In this article, one such strategy – communicative practices associated with the C-reactive protein point-of care test – is investigated. Building on a collection of 31 videorecorded consultations from Danish primary care, and using conversation analysis, this study finds that the rapid test can be used throughout the consultation to incrementally build the case for a nonantibiotic treatment recommendation, both when the test result is forecast and reported. The study also finds that the format of reports of elevated results differs from that of ‘normal’ results, resulting in a subtle shift of authority from doctor to test.References
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Akkerman, A. E. (2005) Determinants of antibiotic overprescribing in respiratory tract infections in general practice. Journal of Antimicrobial Chemotherapy 56 (5): 930–936. https://doi.org/10.1093/jac/dki283
André, M., Odenholt, I. and Schwan, Å. (2002) Upper respiratory tract infections in general practice: Diagnosis, antibiotic prescribing, duration of symptoms and use of diagnostic tests. Scandinavian Journal of Infectious Diseases 34 (12): 880–886. https://doi.org/10.1080/0036554021000026952
Bjerrum, L., Gahrn-Hansen, B., Hansen, M. P., Cordoba Currea, G. C., Aabenhus, R. and Monrad, R. N. (2014) DSAM-Vejledning om Luftvejsinfektioner-Diagnose og Behandling. Copenhagen: Dansk Selskab for Almen Medicin.
Butler, C. C., Simpson, S. and Wood, F. (2008) General practitioners’ perceptions of introducing near-patient testing for common infections into routine primary care: A qualitative study. Scandinavian Journal of Primary Health Care 26 (1): 17–21. https://doi.org/10.1080/02813430701726285
Cals, J. W. L., Butler, C. C., Hopstaken, R. M., Hood, K. and Dinant, G.-J. (2009) 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. British Medical Journal 338 (1): b1374. https://doi.org/10.1136/bmj.b1374
Cals, J. W. L., de Bock, L., Beckers, P.-J. H. W., Francis, N. A., Hopstaken, R. M., Hood, K. and Dinant, G.-J. (2013) Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial. Annals of Family Medicine 11 (2): 157–164. https://doi.org/10.1370/afm.1477
Cals, J. W. L., Schot, M. J. C., de Jong, S. A. M., Dinant, G.-J. and Hopstaken, R. M. (2010) Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: A randomized controlled trial. Annals of Family Medicine 8 (2): 124–133. https://doi.org/10.1370/afm.1090
Cordoba, G., Siersma, V., Lopez-Valcarcel, B., Bjerrum, L., Llor, C., Aabenhus, R. and Makela, M. (2015) Prescribing style and variation in antibiotic prescriptions for sore throat: Cross-sectional study across six countries. BMC Family Practice 16 (1): 7. https://doi.org/10.1186/s12875-015-0224-y
Falk, G. and Fahey, T. (2008) C-reactive protein and community-acquired pneumonia in ambulatory care: Systematic review of diagnostic accuracy studies. Family Practice 26 (1): 10–21. https://doi.org/10.1093/fampra/cmn095
Gutzmer, K. and Beach, W. A. (2015) ‘Having an ovary this big is not normal’: Physicians’ use of normal to assess wellness and sickness during oncology interviews. Health Communication 30 (1): 8–18. https://doi.org/10.1080/10410236.2014.881176
Harbarth, S. and Samore, M. H. (2005) Antimicrobial resistance determinants and future control. Emerging Infectious Diseases 11 (6): 794-801. https://doi.org/10.3201/eid1106.050167
Happy Audit Projekt (2008) Vejledning i Diagnostik og Behandling af Luftvejsinfektioner i Almen Praksis. Odense, Denmark: Happy Audit.
Heath, C. (1992) The delivery and reception of diagnosis in the general practice consultation. In P. Drew and J. Heritage (eds) Talk at Work: Interaction in Institutional Settings, 235–267. Cambridge: Cambridge University Press.
Heinemann, T. and Steensig, J. (2017) Three imperative action formats in Danish talk-in-interaction: The case of imperative + modal particles bare and lige. In M.-L. Sorjonen, L. Raevaara and E. Couper-Kuhlen (eds) Imperative Turns at Talk: The Design of Directives in Action, 139–173. Amsterdam: John Benjamins.
Heinemann, T. and Steensig, J. (2018) Justifying departures from progressivity: The Danish turn-initial particle altså. In J. Heritage and M.-L. Sorjonen (eds) Between Turn and Sequence: Turn-Initial Particles across Languages, 433–462. Amsterdam: John Benjamins.
Heritage, J. and Clayman, S. (2010) Talk in Action: Interactions, Identities, and Institutions. Malden, MA: Wiley-Blackwell. https://doi.org/10.1002/9781444318135
Heritage, J. and Robinson, J. (2006) Accounting for the visit: Giving reasons for seeking medical care. In J. Heritage and D. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients, 48–85. Cambridge: Cambridge University Press.
Heritage, J. and Stivers, T. (1999) Online commentary in acute medical visits: A method of shaping patient expectations. Social Science and Medicine 49 (11): 1501–1517. https://doi.org/10.1016/S0277-9536(99)00219-1
Holm, A., Pedersen, S. S., Nexoe, J., Obel, N., Nielsen, L. P., Koldkjaer, O. and Pedersen, C. (2007) Procalcitonin versus C-reactive protein for predicting pneumonia in adults with lower respiratory tract infection in primary care. British Journal of General Practice 57 (540): 555–560.
Hopstaken, R. M., Stobberingh, E. E., Knottnerus, J. A., Muris, J. W. M., Nelemans, P., Rinkens, P. E. L. M. and Dinant, G. J. (2005) Clinical items not helpful in differentiating viral from bacterial lower respiratory tract infections in general practice. Journal of Clinical Epidemiology 58 (2): 175–183. https://doi.org/10.1016/j.jclinepi.2004.08.004
Huang, Y., Chen, R., Wu, T., Wei, X. and Guo, A. (2013) Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: A systematic review and meta-analysis of primary care studies. British Journal of General Practice 63 (616): 787–794. https://doi.org/10.3399/bjgp13X674477
Ijäs-Kallio, T., Ruusuvuori, J. and Peräkylä, A. (2010) Patient resistance towards diagnosis in primary care: Implications for concordance. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 14 (5): 505–522. https://doi.org/10.1177/1363459309360798
Little, P., Stuart, B., Francis, N., Douglas, E. et al. (2013) Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: A multinational, cluster, randomised, factorial, controlled trial. Lancet 382 (9899): 1175–1182. https://doi.org/10.1016/S0140-6736(13)60994-0
Llor, C. and Bjerrum, L. (2014) Antimicrobial resistance: Risk associated with antibiotic overuse and initiatives to reduce the problem. Therapeutic Advances in Drug Safety 5 (6): 229–241. https://doi.org/10.1177/2042098614554919
Mangione-Smith, R., McGlynn, E. A., Elliott, M. N., Krogstad, P. and Brook, R. H. (1999) The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics 103 (4): 711–718. https://doi.org/10.1542/peds.103.4.711
Maynard, D. W. (2003) Bad News, Good News: Conversational Order in Everyday Talk and Clinical Setting. Chicago: University of Chicago Press.
Maynard, D. W. (2004) On predicating a diagnosis as an attribute of a person. Discourse Studies 6 (1): 53–76. https://doi.org/10.1177/1461445604039439
Peräkylä, A. (1998) Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly 61 (4): 301. https://doi.org/10.2307/2787032
Peräkylä, A. (2002) Agency and authority: Extended responses to diagnostic statements in primary care encounters. Research on Language and Social Interaction 35 (2): 219–247. https://doi.org/10.1207/S15327973RLSI3502_5
Pomerantz, A. (1986) Extreme case formulations: A way of legitimizing claims. Human Studies 9 (2–3): 219–229. https://doi.org/10.1007/BF00148128
Pomerantz, A. and Rintel, E. S. (2004) Practices for reporting and responding to test results during medical consultations: Enacting the roles of paternalism and independent expertise. Discourse Studies 6 (1): 9–26. https://doi.org/10.1177/1461445604039437
Shorter, E. (1985) Bedside Manners: The Troubled History of Doctors and Patients. New York: Simon and Schuster.
Sigurðardóttir, N. R., Nielsen, A. B. S., Munck, A. and Bjerrum, L. (2015) Appropriateness of antibiotic prescribing for upper respiratory tract infections in general practice: Comparison between Denmark and Iceland. Scandinavian Journal of Primary Health Care 33 (4): 269–274. https://doi.org/10.3109/02813432.2015.1114349
Steensig, J. and Asmuss, B. (2005) Notes on disaligning ‘yes but’ initiated utterances in German and Danish conversations. In A. Hakulinen and M. Selting (eds) Syntax and Lexis in Conversation: Studies on the Use of Linguistic Resources in Talk-in-Interaction, 349–373. Amsterdam: John Benjamins.
Stivers, T. (1998) Prediagnostic commentary in veterinarian-client interaction. Research on Language and Social Interaction 31 (2): 241–277. https://doi.org/10.1207/s15327973rlsi3102_4
Stivers, T. (2007) Prescribing under Pressure: Parent-Physician Conversations and Antibiotics. Oxford: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195311150.001.0001
Tonkin-Crine, S., Yardley, L. and Little, P. (2011) Antibiotic prescribing for acute respiratory tract infections in primary care: A systematic review and meta-ethnography. Journal of Antimicrobial Chemotherapy 66 (10): 2215–2223. https://doi.org/10.1093/jac/dkr279
Wood, F., Brookes-Howell, L., Hood, K., Cooper, L., Verheij, T., Goossens and Butler, C. C. (2011) A multi-country qualitative study of clinicians’ and patients’ views on point of care tests for lower respiratory tract infection. Family Practice 28 (6): 661–669. https://doi.org/10.1093/fampra/cmr031
Akkerman, A. E. (2005) Determinants of antibiotic overprescribing in respiratory tract infections in general practice. Journal of Antimicrobial Chemotherapy 56 (5): 930–936. https://doi.org/10.1093/jac/dki283
André, M., Odenholt, I. and Schwan, Å. (2002) Upper respiratory tract infections in general practice: Diagnosis, antibiotic prescribing, duration of symptoms and use of diagnostic tests. Scandinavian Journal of Infectious Diseases 34 (12): 880–886. https://doi.org/10.1080/0036554021000026952
Bjerrum, L., Gahrn-Hansen, B., Hansen, M. P., Cordoba Currea, G. C., Aabenhus, R. and Monrad, R. N. (2014) DSAM-Vejledning om Luftvejsinfektioner-Diagnose og Behandling. Copenhagen: Dansk Selskab for Almen Medicin.
Butler, C. C., Simpson, S. and Wood, F. (2008) General practitioners’ perceptions of introducing near-patient testing for common infections into routine primary care: A qualitative study. Scandinavian Journal of Primary Health Care 26 (1): 17–21. https://doi.org/10.1080/02813430701726285
Cals, J. W. L., Butler, C. C., Hopstaken, R. M., Hood, K. and Dinant, G.-J. (2009) 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. British Medical Journal 338 (1): b1374. https://doi.org/10.1136/bmj.b1374
Cals, J. W. L., de Bock, L., Beckers, P.-J. H. W., Francis, N. A., Hopstaken, R. M., Hood, K. and Dinant, G.-J. (2013) Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial. Annals of Family Medicine 11 (2): 157–164. https://doi.org/10.1370/afm.1477
Cals, J. W. L., Schot, M. J. C., de Jong, S. A. M., Dinant, G.-J. and Hopstaken, R. M. (2010) Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: A randomized controlled trial. Annals of Family Medicine 8 (2): 124–133. https://doi.org/10.1370/afm.1090
Cordoba, G., Siersma, V., Lopez-Valcarcel, B., Bjerrum, L., Llor, C., Aabenhus, R. and Makela, M. (2015) Prescribing style and variation in antibiotic prescriptions for sore throat: Cross-sectional study across six countries. BMC Family Practice 16 (1): 7. https://doi.org/10.1186/s12875-015-0224-y
Falk, G. and Fahey, T. (2008) C-reactive protein and community-acquired pneumonia in ambulatory care: Systematic review of diagnostic accuracy studies. Family Practice 26 (1): 10–21. https://doi.org/10.1093/fampra/cmn095
Gutzmer, K. and Beach, W. A. (2015) ‘Having an ovary this big is not normal’: Physicians’ use of normal to assess wellness and sickness during oncology interviews. Health Communication 30 (1): 8–18. https://doi.org/10.1080/10410236.2014.881176
Harbarth, S. and Samore, M. H. (2005) Antimicrobial resistance determinants and future control. Emerging Infectious Diseases 11 (6): 794-801. https://doi.org/10.3201/eid1106.050167
Happy Audit Projekt (2008) Vejledning i Diagnostik og Behandling af Luftvejsinfektioner i Almen Praksis. Odense, Denmark: Happy Audit.
Heath, C. (1992) The delivery and reception of diagnosis in the general practice consultation. In P. Drew and J. Heritage (eds) Talk at Work: Interaction in Institutional Settings, 235–267. Cambridge: Cambridge University Press.
Heinemann, T. and Steensig, J. (2017) Three imperative action formats in Danish talk-in-interaction: The case of imperative + modal particles bare and lige. In M.-L. Sorjonen, L. Raevaara and E. Couper-Kuhlen (eds) Imperative Turns at Talk: The Design of Directives in Action, 139–173. Amsterdam: John Benjamins.
Heinemann, T. and Steensig, J. (2018) Justifying departures from progressivity: The Danish turn-initial particle altså. In J. Heritage and M.-L. Sorjonen (eds) Between Turn and Sequence: Turn-Initial Particles across Languages, 433–462. Amsterdam: John Benjamins.
Heritage, J. and Clayman, S. (2010) Talk in Action: Interactions, Identities, and Institutions. Malden, MA: Wiley-Blackwell. https://doi.org/10.1002/9781444318135
Heritage, J. and Robinson, J. (2006) Accounting for the visit: Giving reasons for seeking medical care. In J. Heritage and D. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients, 48–85. Cambridge: Cambridge University Press.
Heritage, J. and Stivers, T. (1999) Online commentary in acute medical visits: A method of shaping patient expectations. Social Science and Medicine 49 (11): 1501–1517. https://doi.org/10.1016/S0277-9536(99)00219-1
Holm, A., Pedersen, S. S., Nexoe, J., Obel, N., Nielsen, L. P., Koldkjaer, O. and Pedersen, C. (2007) Procalcitonin versus C-reactive protein for predicting pneumonia in adults with lower respiratory tract infection in primary care. British Journal of General Practice 57 (540): 555–560.
Hopstaken, R. M., Stobberingh, E. E., Knottnerus, J. A., Muris, J. W. M., Nelemans, P., Rinkens, P. E. L. M. and Dinant, G. J. (2005) Clinical items not helpful in differentiating viral from bacterial lower respiratory tract infections in general practice. Journal of Clinical Epidemiology 58 (2): 175–183. https://doi.org/10.1016/j.jclinepi.2004.08.004
Huang, Y., Chen, R., Wu, T., Wei, X. and Guo, A. (2013) Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: A systematic review and meta-analysis of primary care studies. British Journal of General Practice 63 (616): 787–794. https://doi.org/10.3399/bjgp13X674477
Ijäs-Kallio, T., Ruusuvuori, J. and Peräkylä, A. (2010) Patient resistance towards diagnosis in primary care: Implications for concordance. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 14 (5): 505–522. https://doi.org/10.1177/1363459309360798
Little, P., Stuart, B., Francis, N., Douglas, E. et al. (2013) Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: A multinational, cluster, randomised, factorial, controlled trial. Lancet 382 (9899): 1175–1182. https://doi.org/10.1016/S0140-6736(13)60994-0
Llor, C. and Bjerrum, L. (2014) Antimicrobial resistance: Risk associated with antibiotic overuse and initiatives to reduce the problem. Therapeutic Advances in Drug Safety 5 (6): 229–241. https://doi.org/10.1177/2042098614554919
Mangione-Smith, R., McGlynn, E. A., Elliott, M. N., Krogstad, P. and Brook, R. H. (1999) The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics 103 (4): 711–718. https://doi.org/10.1542/peds.103.4.711
Maynard, D. W. (2003) Bad News, Good News: Conversational Order in Everyday Talk and Clinical Setting. Chicago: University of Chicago Press.
Maynard, D. W. (2004) On predicating a diagnosis as an attribute of a person. Discourse Studies 6 (1): 53–76. https://doi.org/10.1177/1461445604039439
Peräkylä, A. (1998) Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly 61 (4): 301. https://doi.org/10.2307/2787032
Peräkylä, A. (2002) Agency and authority: Extended responses to diagnostic statements in primary care encounters. Research on Language and Social Interaction 35 (2): 219–247. https://doi.org/10.1207/S15327973RLSI3502_5
Pomerantz, A. (1986) Extreme case formulations: A way of legitimizing claims. Human Studies 9 (2–3): 219–229. https://doi.org/10.1007/BF00148128
Pomerantz, A. and Rintel, E. S. (2004) Practices for reporting and responding to test results during medical consultations: Enacting the roles of paternalism and independent expertise. Discourse Studies 6 (1): 9–26. https://doi.org/10.1177/1461445604039437
Shorter, E. (1985) Bedside Manners: The Troubled History of Doctors and Patients. New York: Simon and Schuster.
Sigurðardóttir, N. R., Nielsen, A. B. S., Munck, A. and Bjerrum, L. (2015) Appropriateness of antibiotic prescribing for upper respiratory tract infections in general practice: Comparison between Denmark and Iceland. Scandinavian Journal of Primary Health Care 33 (4): 269–274. https://doi.org/10.3109/02813432.2015.1114349
Steensig, J. and Asmuss, B. (2005) Notes on disaligning ‘yes but’ initiated utterances in German and Danish conversations. In A. Hakulinen and M. Selting (eds) Syntax and Lexis in Conversation: Studies on the Use of Linguistic Resources in Talk-in-Interaction, 349–373. Amsterdam: John Benjamins.
Stivers, T. (1998) Prediagnostic commentary in veterinarian-client interaction. Research on Language and Social Interaction 31 (2): 241–277. https://doi.org/10.1207/s15327973rlsi3102_4
Stivers, T. (2007) Prescribing under Pressure: Parent-Physician Conversations and Antibiotics. Oxford: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195311150.001.0001
Tonkin-Crine, S., Yardley, L. and Little, P. (2011) Antibiotic prescribing for acute respiratory tract infections in primary care: A systematic review and meta-ethnography. Journal of Antimicrobial Chemotherapy 66 (10): 2215–2223. https://doi.org/10.1093/jac/dkr279
Wood, F., Brookes-Howell, L., Hood, K., Cooper, L., Verheij, T., Goossens and Butler, C. C. (2011) A multi-country qualitative study of clinicians’ and patients’ views on point of care tests for lower respiratory tract infection. Family Practice 28 (6): 661–669. https://doi.org/10.1093/fampra/cmr031
Published
2018-10-26
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How to Cite
Lindell, J. (2018). Testing for resistance: Point-of-care testing as a communicational tool in antibiotic prescribing. Communication and Medicine, 14(3), 229-240. https://doi.org/10.1558/cam.32191
