The impact of C-reactive protein testing on treatmentseeking behavior and patients’ attitudes toward their care in Myanmar and Thailand

Rachel C. Greer; Thomas Althaus; Sabine Dittrich; Christopher C. Butler; Phaik Yeong Cheah; Tri Wangrangsimakul; Frank M. Smithuis; Nicolas P.J. Day; Yoel Lubell

doi:10.4081/hls.2023.11278

Authors

Rachel C. Greer
rachel@tropmedres.ac
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom. https://orcid.org/0000-0001-9327-0234
Thomas Althaus The Department of Health Action, Monaco, Monaco; Monaco Scientific Centre, Monaco, Monaco. https://orcid.org/0000-0002-6997-3877
Sabine Dittrich Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; FIND, global alliance for diagnostic, Geneva, Switzerland; Deggendorf Institute of Technology, European- Campus Rottal Inn, Pfarrkirchen, Germany. https://orcid.org/0000-0002-4522-2788
Christopher C. Butler Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Phaik Yeong Cheah Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom. https://orcid.org/0000-0001-6327-3266
Tri Wangrangsimakul Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom. https://orcid.org/0000-0003-0430-5699
Frank M. Smithuis Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Medical Action Myanmar, Yangon, Myanmar. https://orcid.org/0000-0002-4704-9915
Nicolas P.J. Day Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, Thailand.
Yoel Lubell Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, Thailand. https://orcid.org/0000-0002-0237-1070

C-reactive protein (CRP) point-of-care testing can reduce antibiotic prescribing in primary care patients with febrile and respiratory illness, yet little is known about its effects on treatment-seeking behavior. If patients go on to source antibiotics elsewhere, the impact of CRP testing will be limited. A randomized controlled trial assessed the impact of CRP testing on antibiotic prescriptions in Myanmar and Thai primary care patients with a febrile illness. Here we report patients’ treatmentseeking behavior before and during the twoweek study period. Self-reported antibiotic use is compared against urine antibacterial activity. Patients’ opinions towards CRP testing were evaluated. Antibiotic use before study enrolment was reported by 5.4% while antimicrobial activity was detected in 20.8% of samples tested. During the study period, 14.8% of the patients sought additional healthcare, and 4.3% sourced their own antibiotics. Neither were affected by CRP testing. Overall, patients’ satisfaction with their care and CRP testing was high. CRP testing did not affect patients’ treatment-seeking behavior during the study period whilst modestly reducing antibiotic prescriptions. CRP testing appears to be acceptable to patients and their caregivers.

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Greer, R. C., Althaus, T., Dittrich, S., Butler, C. C., Cheah, P. Y., Wangrangsimakul, T., Smithuis, F. M., Day, N. P., & Lubell, Y. (2023). The impact of C-reactive protein testing on treatmentseeking behavior and patients’ attitudes toward their care in Myanmar and Thailand. Healthcare in Low-Resource Settings, 11(1). https://doi.org/10.4081/hls.2023.11278