Implementation and Use of Point-of-Care C-Reactive Protein Testing in Nursing Homes

Abstract

Objectives: This study evaluated logistics, process data, and barriers/facilitators for the implementation and use of C-reactive protein point-of-care testing (CRP POCT) for suspected lower respiratory tract infections (LRTIs) in nursing home (NH) residents. Design: This process evaluation was performed alongside a cluster randomized, controlled trial (UPCARE study) to evaluate the effect of CRP POCT on antibiotic prescribing for suspected LRTIs in NH residents. Setting and Participants: Eleven NHs in the Netherlands. Methods: Data sources for process data regarding intervention quality included a questionnaire among NH staff, logs, reports, and CRP POCT-analyzer records. Barriers and facilitators for implementation were assessed in focus group interviews with physicians and nurses from 3 NHs. Results: Correct patient selection for CRP POCT and generally continued CRP POCT use indicated good fidelity. The initial training and training of new employees seemed to fit the need, but some POCT-user group sizes had increased over time, which could have impeded frequent use. Users were generally satisfied with CRP POCT and perceived its use feasible and relevant. Facilitators for implementation were initial commitment and active initiation, followed by continued attention and enthusiasm for building routine practice and trust. Short lines of communication between staff, short distance to the POCTanalyzer, 24/7 coverage of staff, and a clear task division facilitated continued attention and routine practice. Conclusions and Implications: This process evaluation showed sufficient quality of providing CRP POCT in Dutch NHs. We processed findings of intervention quality and implementation knowledge into key

Perceptions of C-reactive Protein Measurement Among General Physicians: A Qualitative Study on Diagnostic Value, Clinical Dilemmas, and Professional Growth

“…This corroborates findings from previous studies that have established CRP as a valuable diagnostic tool in various clinical scenarios, including infections and inflammatory conditions [ 16 , 17 ]. CRP's utility in enhancing communication with specialists by providing a common understanding of patient severity further underscores its importance in clinical practice [ 18 ]. As noted in other studies, this shared understanding is crucial in ensuring timely and effective patient care [ 18 ].…”

“…CRP's utility in enhancing communication with specialists by providing a common understanding of patient severity further underscores its importance in clinical practice [ 18 ]. As noted in other studies, this shared understanding is crucial in ensuring timely and effective patient care [ 18 ]. In general medicine, negative impressions regarding CRP among general physicians can be caused by the indistinguishable usage of laboratory tests, causing misleading clinical diagnosis and management [ 19 ].…”

Preparing of Point-of-Care Reagents for Risk Assessment in the Elderly at Home by a Home-Visit Nurse and Verification of Their Analytical Accuracy

“…Thus, we speculated that a combination of POCT of CRP and NLR would assist in risk management for older patients at home. Several studies have been performed to test the efficacy of POCT in nursing homes [20,21], but the types of POCT reagents that are useful for risk assessment of older patients at home, their effectiveness, and their standard values remain unclear.…”