Evaluation of the test accuracy of a SARS-CoV-2 rapid antigen test in symptomatic community dwelling individuals in the Netherlands.

BACKGROUND: SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction (qRT-PCR) is well suited for the diagnosis of clinically ill patients requiring treatment. Application for community testing of symptomatic individuals for disease control purposes however raises challenges. SARS-CoV-2 rapid antigen tests might offer an alternative, but quality evidence on their performance is limited. METHODS: We conducted an evaluation of the test accuracy of the 'BD Veritor System for Rapid Detection of SARS-CoV-2' (VRD) compared to qRT-PCR on combined nose/throat swabs obtained from symptomatic individuals at Municipal Health Service (MHS) COVID-19 test centers in the Netherlands. In part one of the study, with the primary objective to evaluate test sensitivity and specificity, all adults presenting at one MHS test center were eligible for inclusion. In part two, with the objective to evaluate test sensitivity stratified by Ct (cycle threshold)-value and time since symptom onset, adults who had a positive qRT-PCR obtained at a MHS test center were eligible. FINDINGS: In part one (n = 352) SARS-CoV-2 prevalence was 4.8%, overall specificity 100% (95%CI: 98·9%-100%) and sensitivity 94·1% (95%CI: 71·1%-100%). In part two (n = 123) the sensitivity was 78·9% (95%CI: 70·6%-85·7%) overall, 89·4% (95% CI: 79·4%-95·6%) for specimen obtained within seven days after symptom onset and 93% (95% CI: 86%-97.1%) for specimen with a Ct-value below 30. INTERPRETATION: The VRD is a promising diagnostic for COVID-19 testing of symptomatic community-dwelling individuals within seven days after symptom onset in context of disease control. Further research on practical applicability and the optimal position within the testing landscape is needed.

Management of acute cough: comparisons between Belgian and Dutch GPs.

OBJECTIVES: In Europe there are large variations in overall outpatient antibiotic use, even between two neighbouring countries as Belgium and the Netherlands. We aimed to compare the management of acute cough between Belgian and Dutch general practitioners (GPs). METHODS: In cross-sectional studies in Belgium and the Netherlands, 71 Belgian and 84 Dutch GPs included adult patients consulting for acute cough. Differences in antibiotic prescription rates, the percentage of first-choice antibiotics (i.e. tetracyclines and broad-spectrum penicillins) and bronchodilator prescription rates were assessed by using Generalised Estimates Equations to adjust for clustering of patients within GPs. RESULTS: In Belgium 324/810 patients (40%) were prescribed an antibiotic compared with 101/309 (33%) in the Netherlands (adjusted OR (95% CI) 1.28 (0.91-1.83)). Belgian GPs prescribed fewer first-choice antibiotics compared with Dutch GPs: 124/324 (38%) versus 67/101 (66%) (adjusted OR (95% CI) 0.39 (0.22-0.72)). In both countries, 17% of the patients were prescribed a bronchodilator. CONCLUSIONS: Antibiotic prescription rates for adult patients with acute cough were not significantly higher in Belgian than in Dutch general practice at the 5% significance level. Dutch GPs' antibiotic prescriptions were more in line with national guidelines. Bronchodilator prescription rates were similar. Because Dutch GPs probably encountered more severe cases of acute cough compared with their Belgian colleagues, the observed prescribing differences might be underestimated.

Antibiotics for acute respiratory tract symptoms: patients' expectations, GPs' management and patient satisfaction.

BACKGROUND: GPs often assume that prescribing antibiotics increases patient satisfaction. OBJECTIVE: The purpose of this study was to determine the associations between receiving antibiotics and information/reassurance on the one hand and patients' satisfaction on the other in patients with acute respiratory tract symptoms, and to assess whether this relationship is influenced by patients' expectations. METHODS: Questionnaires were distributed among patients presenting with acute respiratory tract symptoms in 51 general practices (122 GPs) in the region of Utrecht, The Netherlands. Outcome measures were patients' expectations, GPs' management regarding antibiotic prescribing and information/reassurance, and patient satisfaction. RESULTS: Information/reassurance was expected by 90% of the respondents (916/1014); 97% of those actually received it (888/916). Fifty percent expected antibiotics (467/926), while 73% of them received antibiotics (343/467). Receiving information/reassurance was more strongly associated with satisfaction than an antibiotic prescription [adjusted odds ratio (OR) 10.6; 95% confidence interval (CI) 5.6-20.1, and adjusted OR 2.2; 95% CI 1.3-3.8, respectively]. Patients' expectations towards antibiotics modified these associations; in patients not expecting antibiotics, receiving information/reassurance was the only independent determinant of satisfaction (adjusted OR 21.6; 95% CI 7.4-62.7) and in patients who expected antibiotics, actually receiving antibiotics and receiving information/reassurance were equally important determinants of satisfaction (adjusted OR 3.8; 95% CI 1.9-7.5, and adjusted OR 4.7; 95% CI 1.9-11.9, respectively). CONCLUSION: GPs should first explore patients' expectations about antibiotic treatment before giving information about the self-limitedness of respiratory tract symptoms and (in)effectiveness of antibiotics in order to enhance shared decision making and rationalize antibiotic prescribing.

Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial.

OBJECTIVES: To assess the effectiveness of a multiple intervention aimed at reducing antibiotic prescription rates for symptoms of the respiratory tract in primary care. DESIGN: Randomised controlled trial. SUBJECTS: Twelve peer review groups including 100 general practitioners with their collaborating pharmacists in the region of Utrecht, Netherlands. INTERVENTION: The intervention consisted of group education meetings, with a consensus procedure on indication for and type of antibiotics and with training in communication skills; monitoring and feedback on prescribing behaviour; group education for assistants of general practitioners and pharmacists; and education material for patients. The control group did not receive any of these elements. MAIN OUTCOME MEASURES: Antibiotic prescription rates for acute symptoms of the respiratory tract and patients' satisfaction. RESULTS: 89 general practitioners completed the study (89%). At baseline, prescription rates for antibiotics for respiratory tract symptoms did not differ between intervention and control group (27% v 29%, respectively). After nine months, the prescription rates in the intervention group fell to 23%, whereas the control group's rose to 37% (mean difference in change -12%, 95% confidence interval -18.9% to -4.0%). Multilevel analysis confirmed the results of the unadjusted analysis (intervention effect -10.7%, -20.3% to -1.0%). Patients' satisfaction was high and did not differ in the two groups at baseline or after the intervention. CONCLUSIONS: A multiple intervention reduced prescribing rates of antibiotics for respiratory tract symptoms while maintaining a high degree of satisfaction among patients. Further research should focus on the sustainability and cost effectiveness of this intervention.

Patients' and doctors' views on respiratory tract symptoms.

OBJECTIVE: To explore the views of patients and doctors on respiratory tract symptoms. DESIGN: Transversal survey among patients and general practitioners. SETTING: Primary health care and community. SUBJECTS: 51 patients attending a general practitioner, 38 patients in the community, 7 general practitioners. MAIN OUTCOME MEASURES: Patients' and doctors' views on respiratory tract symptoms and differences between them: agreement with statements rated on a 5-point scale, ranging from "strongly disagree" to "strongly agree." RESULTS: Patients less than doctors endorsed the self-limiting character of cough, sore throat and earache (mean 3.1, 3.4 and 2.9 versus 4.1, 4.1 and 3.7) and patients--much more than doctors--rated antibiotics as being necessary for cough and sore throat (mean 2.7 and 2.9 versus 1.7 and 17) and believed that antibiotics speed recovery (mean 3.7 versus 2.0). However, there was little difference relating to the necessity to see a doctor after some time period. CONCLUSION: Patients appeared to differ from doctors in views on respiratory tract symptoms. The results stress the importance of exploring patients' views when being confronted by patients suffering from respiratory tract symptoms.