Date of Award
MSc by research (Master of Science by research)
Dr Gráinne Cousins
Professor Paul Gallagher
Group A Beta Haemolytic Streptococci, Antibiotics, Pharyngitis, Point Of Care Testing
Up to 75% of cases of pharyngitis are inappropriately prescribed antibiotics. In those with a bacterial infection, one strain could be treated with antibiotics, Group A β-Haemolytic Streptococci (GABHS), to minimise complications. The Centor Criteria, a clinical prediction rule, is recommended by UK and Irish General Practitioner guidelines for use in primary care. The Infectious Diseases Society of America recommends the use of RADT in combination with the Centor Criteria, to improve antibiotic prescribing. The aim of this study was to evaluate the effectiveness of a community pharmacy intervention, involving the Centor Criteria and Rapid Antigen Detection Testing (RADT) on General Practitioner (GP) visits and antibiotic prescribing.
A non-randomised controlled, parallel trial of adults aged ≥ 18 years, presenting to one of 20 community pharmacies in Ireland with an uncomplicated sore throat. Patients presenting to pharmacy with a sore throat lasting between 3 and 10 days, with no reported symptom improvement were invited to participate in the study. Those in the intervention group were evaluated using the Centor Criteria and if necessary RADT, by the pharmacist. Those in the control group received usual care from their pharmacy team. Those with a Centor score of 1 or more were included in the study. All patients were followed up at 7 days to determine GP visits and antibiotic consumption. Secondary outcomes included; appropriateness of antibiotic (based on Centor score, RADT results and type of antibiotic prescribed), self reported antibiotic adherence, time to recovery and patient satisfaction.
Five intervention pharmacies and nine control pharmacies recruited patients. At baseline patient groups were similar with 35 patients participating in the intervention and 79 patients in the control. Results of the study show that the intervention in combination with the pharmacist advice could reduce GP visits by approximately one-third.
At follow up there were 29 patients in the intervention group and 66 patients in the control group. There were no significant differences across treatment groups for attendance at GP with 24.14% attending in the intervention group and 21.12% in the control (OR = 1.24, 95% CI = 0.42, 3.63, p = 0.7). Antibiotic prescription was similar across treatment groups with 20.69% of those in the intervention group prescribed antibiotics and 19.7% in the control group prescribed antibiotics. Inappropriate prescription of antibiotics was found to be high in both treatment groups, based on the clinical presentation of patients at day one. Patient satisfaction was high with 94.12% of patients stated that they would use the service again in the future.
Patients are open to community pharmacists providing such point of care testing services, with many stating they would like to have more of these services on offer through the pharmacy. From the data presented it the intervention does not have a significant impact on GP visits or antibiotic prescribing. While further study is required on this intervention in the community pharmacy setting in Ireland, the study shows that pharmacists in combination with the intervention presented, have the potential to reduce GP visits and improve the rational use of medicines.
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O'Neill C. Impact of a pharmacy-led screening service for group A beta-haemolytic streptococci, on general practitioner visits and antibiotic consumption: A non-randomized controlled study [MSc Thesis]. Dublin: Royal College of Surgeons in Ireland; 2018.