Doris-Ann Williams MBE
Chief Executive, BIVDA
As the NHS is simply not set up to allow for adoption of IVDs within GP surgeries to be centrally funded, clinicians themselves must do more to make systematic changes.
CRP tests key to reducing guess work and drug wastage
The overprescribing of antibiotics, often in cases where their use is unwarranted, is a hangover from before awareness of antimicrobial resistance where antibiotics were used ‘just in case’, says BIVDA Chief Executive, Doris-Ann Williams.
“All too often, it’s a case of people being prescribed antibiotics because there is a desire to take something home with them – an expectation to get better instantly,” she said.
An alternative IVD could well see patients receive more appropriate treatment.
IVDs, or in-vitro diagnostics, are tests commonly performed in hospitals on body fluids or tissues. Increasingly, simple IVD tests are being used effectively by GPs to improve diagnostic processes.
“The challenge is for GPs to educate patients on why taking a CRP test or an alternative IVD could well see them receive more appropriate treatment. Sending someone home with antibiotics who has a viral infection serves to have the opposite effect.”
CRP (C-Reactive Protein) is a substance produced by the liver in response to inflammation. Testing for high levels of it is one way of ascertaining whether the cause of illness is bacterial, and whether antibiotics are a necessary next step or not.
“Information provided by IVDs aids clinicians in piecing together the ‘jigsaw puzzle’ of a patient’s illness.”
GPs hold the key to wider adoption of IVDs
Williams argues that GPs hold the power in terms of taking a more proactive and informed approach to treatment. However, she says a change in attitude is necessary in order for a more widespread adoption of IVDs to take place.
“I think GPs are getting better at not giving out antibiotics unnecessarily, but they’re still not doing the tests. Put simply, that means they’re missing out on vital information that could be used to benefit the patient.”
Cost is undoubtedly an issue with regards to diagnostic stewardship techniques improving amongst GPs, with tests like the CRP often proving more expensive at face value than prescription drugs.
“With most diagnostics, by order of magnitude, tests are about 100 times cheaper than most drugs. But, suddenly we’ve got to a situation where diagnostic tests are more expensive (for GPs) than most antibitotics.”
A CRP test would cost around £3.50 to perform, whereas antibiotics cost somewhere in the region of £1-£1.50 in comparison.
Patient and societal benefits of IVDs must trump costs
Within primary care, successful use of IVDs can go a long way towards reducing the need for unnecessary procedures, follow up visits and antibiotic prescription.
Williams argues that these benefits far outweigh the cost element involved, and has seen first-hand the benefits of GPs adopting IVDs.
“In primary care, the typical approach is ‘go away and come back if you don’t feel better in a week’. But, if you can identify exactly what’s wrong with someone right away, then there is often no need for that repeat visit.”
The benefits of this can be widespread, says Williams.
“People are often referred for chest x-rays, with GPs suspecting something more sinister. A simple test can help to discern what is or isn’t going on, and avoid unnecessary exposure to radiation.”
An x-ray tariff could be as much as £100, far more expensive than many IVD tests that are currently available.
Education and communication key to promotion of IVDs
Without the securing of central NHS funding for equipment and adoption of IVDs likened to ‘Guerrilla warfare’, case studies and education are vital, says Williams.
Both Wales and Scotland, due to their population size and the difference in the way healthcare is funded, are ahead of England when it comes to making use of best practice on IVDs.
Shifts in both the mind-set of patients and the healthcare community in England are needed in order for more clinicians to spread the benefits of IVDs.
“One patient at a practice we’re working with was adamant that he needed antibiotics, and was quite agitated, due to missing work.
His GP did the CRP test, which came back negative, and was therefore able to make it clear to that patient that he simply had to rest up, with the necessary reasoning behind that call.”