Qualitative study to explore the views of general practice staff on the use of point-of-care C reactive protein testing for the management of lower respiratory tract infections in routine general practice in England

Abstract

ObjectivesTo explore the knowledge, skills, attitudes and beliefs of general practice staff about C reactive protein (CRP) point-of-care tests (POCTs) in routine general practice and associated barriers and facilitators to implementing it to improve the management of acute cough.DesignA qualitative methodology including interviews and focus groups using the Com-B framework to understand individuals’ behaviour to implement CRP POCT in routine general practice. Data were analysed inductively and then aligned to the Com-B framework.SettingA service evaluation of CRP POCT over a 6-month period was previously conducted in randomly selected GP practices from a high prescribing National Health Service Clinicial Commissioning Groups in England. All 11 intervention practices (eight accepting CRPs; three declining CRPs) and the eight control practices, which were not offered CRP POCT, were also invited to interview. A further randomly selected practice not allocated to intervention or control was also invited to participate.ParticipantsSeven of eight accepting CRP, one of three declining CRP and four of nine control practices consented to participate. 12 practices and 26 general practice staff participated; 11 interviews, 3 focus groups and 1 hand-written response.ResultsParticipants reported that CRP POCT can increase diagnostic certainty for acute cough, inform appropriate management, manage patient expectations for antibiotics, support patient education and improve appropriate antibiotic prescribing. Reported barriers to implementing CRP POCT included: CRP cost, time, easy access to the POCT machine and effects on clinical workflow. Participants with greater CRP use usually had a dedicated staff member with the machine located in their consultation room.ConclusionsCRP POCT can help general practice staff improve patient care and education if incorporated into routine care, but this will need enthusiasts with dedicated POCT instruments or smaller, cheaper, more portable machines. In addition, funding will be needed to support test costs and staff time.

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

“…A qualitative study explored the views of general practice staff on the use of CRP POCT for the management of lower RTIs in England who felt the test could help general practice staff improve patient care and education if incorporated into routine care, but this would need enthusiasts with dedicated POCT instruments or smaller, cheaper, more portable instruments. 56 …”

“…Barriers and facilitators to CRP POCT adoption A qualitative study explored the views of general practice staff on the use of CRP POCT for the management of lower RTIs in England who felt the test could help general practice staff improve patient care and education if incorporated into routine care, but this would need enthusiasts with dedicated POCT instruments or smaller, cheaper, more portable instruments. 56 A mathematical model for designing networks of CRP POCT could optimise the cost and travel distance for patients to access testing across a given region. 57 A mixed-methods UK study with CRP POCT confirmed costs and funding as important barriers in addition to physical and operational constraints and cited training and the value of a local champion as enablers.…”

How Can National Antimicrobial Stewardship Interventions in Primary Care Be Improved? A Stakeholder Consultation

“…The stakeholders considered it not affordable or practical to deliver. While POC CRP testing is supported by examples of countries with low prescribing rates that routinely use it (e.g., Netherlands) and trial evidence showing it as an effective and safe strategy to reduce antibiotic prescribing for RTIs in general practice [14,35], it may not have sustained effects on prescribing behavior [36] and is often met with mixed views on its usefulness and feasibility from HCPs [37,38]. Moreover, 'co-organizing national AMS events for participants from different professional networks to facilitate multi-disciplinary AMS work' and 'promoting the use of patient records by pharmacists to review whether antibiotics were prescribed appropriately' seemed to be considered by stakeholders as unaffordable; 'providing information on opening hours of local healthcare services' (to reduce prescribing when concerned about limited access to healthcare) was considered unlikely to be effective; and 'providing training and resources to structure the ways of asking patients the right questions about self-limiting infections and identifying red flags to help decide what to advise patients' in community pharmacy was seen as of low relevance.…”

Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices

“…Similar to existing literature, both strategies were seen as ‘clinical tools’ to help manage clinical uncertainty, especially for those still developing clinical skills/experience: DPs were used to safety-net instead of re-consulting [ 27 , 28 , 36 ] and POC-CRPT to help assess illness severity and whether antibiotics are needed [ 23 , 24 , 29 , 30 , 35 , 37 – 39 ]. However, we found that clinical uncertainty about RTIs among experienced clinicians was seen as relatively ‘rare’.…”