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NIHR researchers win Royal College of General Practitioners Paper of the Year


Researchers behind a leading NIHR-funded study that shows a simple finger-prick test could help unnecessary prescribing of antibiotics among patients with chronic obstructive pulmonary disease (COPD), have won a prestigious healthcare award.

The PACE study, led by experts from Cardiff University, the University of Oxford, and from King’s College London, found that using a c-reactive protein (CRP) finger-prick blood test resulted in 20% fewer people using antibiotics for COPD flare-ups. 

Their paper ‘C-reactive Protein guided antibiotic prescribing for COPD exacerbations’ was published in the New England Journal of Medicine last July. Now the researchers have received the Overall Winner of the Research Paper of the Year 2019 award from the Royal College of General Practitioners.

The PACE study was funded by NIHR’s Health Technology Assessment (HTA) Programme and supported by the NIHR Clinical Research Network (CRN). 

Professor Miles Witham, National Speciality Lead for Ageing for the NIHR CRN, said:  

“Antimicrobial resistance is a worldwide threat and this research provides clear evidence that this finger prick test is an important tool that can help tackle it, while enhancing the quality of care for patients with COPD.

“This important study shows the value of promoting and conducting research in primary care, and provides evidence to boost the use of point of care testing for patients at GP surgeries, thereby reducing the burden on busy hospital services.

“The study included both older people and people with multiple long-term conditions, so that clinicians and patients can have confidence that the results apply to a wide range of patients with COPD seen in general practice

“Congratulations to the team for the excellent work that led to this deserved award.”

More than a million people in the UK have COPD, a lung condition associated with smoking and other environmental pollutants. People living with the condition often experience exacerbations, or flare-ups, and when this happens, three out of four are prescribed antibiotics. However, two -thirds of these flare-ups are not caused by bacterial infections and antibiotics often do not benefit patients.

The finger-prick test measures the amount of C- reactive protein (CRP) - a marker of inflammation that rises rapidly in the blood in response to serious infections. People with a COPD flare-up who have a low CRP level in the blood appear to receive little benefit from antibiotic treatment.

Importantly the study’s results show this reduction in antibiotic use among this group of patients did not have a negative effect on their recovery over the first two weeks after their consultation at their GP surgery, or on their well-being or use of health care services over the following six months.

Safely reducing the use of antibiotics using point of care testing in this way may help in the battle against antibiotic resistance.

Chris Butler, Professor of Primary Care, Oxford University, and the study’s co-Chief Investigator,  said:

“This prestigious award from the Royal College of General Practitioners recognises a tremendous contribution by so many people who devoted time, resources, creative energy, and hard work to make the study happen and deliver it's exciting findings that will undoubtedly improve care of people with COPD and help better target antibiotics to those who need it while reducing unnecessary use.

"We are deeply grateful to the NIHR’s HTA Programme, the Clinical Research Network (CRN) and Health and Care Research Wales for funding and supporting the study. We would like to thank the Cardiff and Oxford academic Clinical Trials Units GP practices who implemented the trial, and the some 630 patients who gave their time and data to generate the findings.”

“Most antibiotics are prescribed in primary medical care, and many of these prescriptions do not benefit patients: point-of-care testing is being vigorously promoted as a critical solution for better targeted antibiotic prescribing.

"Ours is the first trial of biomarker guided management of AECOPD in ambulatory care and has found an effect that should be practice changing."

Professor Butler, who is also a practicing GP, highlighted the importance of public contributors  to the success of the project, in particular the late Margaret Barnard: “Margaret made a wonderful contribution to the study, but sadly died from lung cancer during the course of the trial so was not alive to see the results or share in the recognition that this award brings. We want to recognise not only her contribution as an individual, but the importance of PPI in the design and delivery of high-quality, clinically facing, primary care research.”

The team has donated £1,000 prize money to the British Lung Foundation in memory of Margaret Barnard.

The RCGP Research Paper of the Year 2019 Awards were presented in three categories to recognise an individual, or group of researchers who have undertaken and published an exceptional piece of research relating to general practice or primary care.

Professor Martin Marshall, Chair of the Royal College of GPs, said:

“Many congratulations to this year’s Research Paper of the Year winners. High quality research in primary care is essential – now more than ever – as we work to improve the ways in which we practice and deliver care to our patients.”

More information on the study is available on the NIHR’s Funding and Awards website.

Professor and his colleague Professor Nick Francis have previously written about the study in a blog on the NIHR website.