Introducing new point-of-care tests for common infections in publicly funded clinics in South Africa: a qualitative study with primary care clinicians

Abstract

Broad-spectrum antibiotics are routinely prescribed empirically in the resource-poor settings for suspected acute common infections, which drive antimicrobial resistance. Point-of-care testing (POCT) might increase the appropriateness of decisions about whether and which antibiotic to prescribe, but implementation will be most effective if clinician’s perspectives are taken into account.ObjectivesTo explore the perceptions of South African primary care clinicians working in publicly funded clinics about: making antibiotic prescribing decisions for two common infection syndromes (acute cough, urinary tract infection); their experiences of existing POCTs; their perceptions of the barriers and opportunities for introducing (hypothetical) new POCTs.Design, method, participants, settingQualitative semistructured interviews with 23 primary care clinicians (nurses and doctors) at publicly funded clinics in the Western Cape Metro district, South Africa. Data were analysed using thematic analysis.ResultsClinicians reported that their antibiotic prescribing decisions were influenced by their clinical assessment, patient comorbidities, social factors (eg, access to care) and perceived patient expectations. Their experiences with currently available POCTs were largely positive, and they were optimistic about the potential for new POCTs to: support evidence-based prescribing decisions that might reduce unnecessary antibiotic prescriptions; reduce the need for further investigations; support effective communication with patients, especially when antibiotics were unlikely to be of benefit. Resources and workflow disruption were seen as the main barriers to uptake into routine care.ConclusionsClinicians working in publicly funded clinics in the Western Cape Metro of South Africa saw POCTs as potentially useful for positively addressing both clinical and social drivers of the overprescribing of broad-spectrum antibiotics, but were concerned about the resource implications and disruption of existing patient workflows.

In-vitro diagnostic point-of-care tests in paediatric ambulatory care: A systematic review and meta-analysis

“…There are also likely to be important social determinants of prescribing that may override POCT-driven prescribing e.g. parental concern, the potential of rapid deterioration, and especially in LMICs, access to care [31,68,69]. Our data were not able to evaluate if and how parents or carers of children might influence prescribing decisions despite a 'normal' POC result.…”

“…This reduction in antimalarial prescribing was more modest in our systematic review in children only (33%). One reason for this difference, might be that clinicians are more risk averse in children in LMICs where the prevalence of infectious disease, malnutrition and risk of death are greater [68]. Other reasons include perceptions that the risk of taking antimalarials is negligible for individual patients or that in high prevalence areas of malaria transmission, there is a significant false-positive malarial-POCT rate (i.e.…”

Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI

“…60 In a South African study, clinicians saw POCTs as potentially useful for positively addressing both clinical and social drivers of the overprescribing of broad-spectrum antibiotics. 61…”

Point of care biomarkers to guide antibiotic prescription for acute febrile illness in sub-Saharan Africa: promises and caveats

“…As CRP testing mediates its effect on antibiotic consumption via behavioral/prescription changes, its use should be integrated into meaningful clinical guidelines and algorithms. To ensure a good uptake by health care providers, their perceptions on the current practices (guidelines used, antibiotic prescription patterns, indications for hospitalization and referral, patient expectations) and the acceptability and potential use of a POC CRP testing to guide antibiotic prescription would be critical pre-trial information [ 30 ]. The low adherence to CRP-guided antibiotic prescription in the trials in Southeast Asia, with a relatively high number of patients receiving antibiotics despite low CRP values, underscores this point [ 31 ].…”