Near-patient test for C-reactive protein in general practice: Assessment of clinical, organizational, and economic outcomes

Background: The benefits of near-patient, point-of-care tests have not been fully examined. We have assessed the clinical, organizational and economic outcomes of implementing a,near-patient test for C-reactive protein (CRP) in general practice. Methods: In a randomized crossover trial during intervention periods, gener al practitioners (GPs) were allowed to measure CRF within 3, min, using Nyc oCard(R) CRP. During control periods, they had to mail blood samples for CR P measurements to the hospital laboratory and received test results 24-48 h later. Twenty-nine general practice clinics participated (64 GPs), and 185 3 patients were included in the study. Results were evaluated at both the l evel of participating GPs and the level of included patients. Results: For participating GPs, the overall use of erythrocyte sedimentatio n rates (ESRs) decreased by 8% (95% confidence interval, 1-14%) during inte rvention periods, and the number of blood samples mailed to the hospital la boratory decreased by 6% (1-10%). No reduction in the prescription of antib iotics was seen. The proportion of study patients having a follow-up teleph one consultation was reduced from 63% to 53% (P = 0.0001), and patients wit h CRP concentrations >50 mg/L had their antibiotic treatments started earli er when CRP was measured in general practices (P = 0.0161). Conclusion: The implementation of the near-patient CRP test was cost-effect ive mainly on-the basis of a reduction in the use of services from the hosp ital laboratory by GPs. If the implementation is followed by education and clinical guidelines, opportunities exist for additional reduction in the us e of ESR and for a more appropriate use of antibiotics. (C) 1999 American A ssociation for Clinical Chemistry.