Acute services for ARI in the UK are changing rapidly with the advent of ARI hubs and ARI virtual wards, and a variety of models are being adopted around the UK. Clinicians are limited in what symptoms and degree of severity they can assess remotely, and if there is suspicion of more serious illness, then people should be invited to a face-to-face appointment where possible. Although only a small subgroup of people with ARI need a face-to-face appointment, these recommendations may lead to more face-to-face follow-up appointments after remote assessment, and will affect general practices differentially depending on their current threshold of delivering care remotely. Remote antibiotic prescription rates are anticipated to decrease with a corresponding increase in number of face-to-face reviews.
Many primary care settings do not have access to point-of-care CRP testing and therefore may not be able to use it as an adjunct to decision making. While CRP testing may improve clinical decision making around the need to prescribe antibiotics for ARI, it does come with an increased financial and time cost (processing and reviewing of results) that may be difficult for resource-limited primary care services to implement.
Further information on the guidance
This guidance was developed by the NICE’s Guideline Development Team B in accordance with NICE guideline methodology (www.nice.org.uk/media/default/about/what-we-do/our-programmes/developing-nice-guidelines-the-manual.pdf). A Guideline Committee (GC) was established by the team, which incorporated healthcare and allied healthcare professionals (one consultant respiratory physician, one “111” clinical adviser, one consultant geriatrician, one consultant in emergency and intensive care medicine, two general practitioners, one nurse consultant in respiratory medicine, one emergency care practitioner, one advanced clinical practitioner, two consultant microbiologists, and one principal pharmacist) and two lay members.
The guideline is available at https://www.nice.org.uk/guidance/ng237.
The GC identified relevant review questions and collected and appraised clinical and cost effectiveness evidence. Quality ratings of the evidence were based on GRADE methodology (www.gradeworkinggroup.org). These relate to the quality of the available evidence for assessed outcomes or themes rather than the quality of the study. The GC agreed recommendations for clinical practice based on the available evidence or, when evidence was not found, based on their experience and opinion using informal consensus methods.
The scope and the draft of the guideline went through a rigorous reviewing process, in which stakeholder organisations were invited to comment; the GC took all comments into consideration when producing the final version of the guideline.
NICE will conduct regular reviews after publication of the guidance, to determine whether the evidence base has progressed significantly enough to alter the current guideline recommendations and require an update.
How patients were involved in the creation of this article
CP and AT were lay members on the Guideline Committee. Committee members involved in this guideline update included lay members who contributed to the formulation of the recommendations summarised here.