Point-of-care C Reactive Protein for the Diagnosis of Lower Respiratory Tract Infection in NHS Primary Care: a Qualitative Study of Barriers and Facilitators to Adoption

Overview

Journal BMJ Open

Specialty General Medicine

Date 2016 Mar 5

PMID 26940107

Citations 45

Authors

Jeremy R Huddy

Melody Z Ni

James Barlow

Azeem Majeed

George B Hanna

Affiliations

Soon will be listed here.

Abstract

Objectives: Point-of-care (POC) C reactive protein (CRP) is incorporated in National Institute of Health and Care Excellence (NICE) guidelines for the diagnosis of pneumonia, reduces antibiotic prescribing and is cost effective.

Aim: To determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary care for the diagnosis of lower respiratory tract infection.

Design: The study followed a qualitative methodology based on grounded theory. The study was undertaken in 2 stages. Stage 1 consisted of semistructured interviews with 8 clinicians from Europe and the UK who use the test in routine practice, and focused on their subjective experience in the challenges of implementing POC CRP testing. Stage 2 was a multidisciplinary-facilitated workshop with NHS stakeholders to discuss barriers to adoption, impact of adoption and potential adoption scenarios. Emergent theme analysis was undertaken.

Participants: Participants included general practitioners (including those with commissioning experience), biochemists, pharmacists, clinical laboratory scientists and industry representatives from the UK and abroad.

Results: Barriers to the implementation of POC CRP exist, but successful adoption has been demonstrated abroad. Analysis highlighted 7 themes: reimbursement and incentivisation, quality control and training, laboratory services, practitioner attitudes and experiences, effects on clinic flow and workload, use in pharmacy and gaps in evidence.

Conclusions: Successful adoption models from the UK and abroad demonstrate a distinctive pattern and involve collaboration with central laboratory services. Incorporating antimicrobial stewardship into quality improvement frameworks may incentivise adoption. Further research is needed to develop scaling-up strategies to address the resourcing, clinical governance and economic impact of widespread NHS implementation.

Citing Articles

Improving antibiotic prescribing - Recommendations for funding and pricing policies to enhance use of point-of-care tests.

Vogler S, Steigenberger C, Windisch F Health Policy Open. 2024; 7:100129.

PMID: 39430908 PMC: 11488418. DOI: 10.1016/j.hpopen.2024.100129.

Point-of-care tests to manage acute respiratory tract infections in primary care: a systematic review and qualitative synthesis of healthcare professional and patient views.

Hoste M, Borek A, Santillo M, Roberts N, Tonkin-Crine S, Anthierens S J Antimicrob Chemother. 2024; 80(1):29-46.

PMID: 39378128 PMC: 11695907. DOI: 10.1093/jac/dkae349.

[Audit of Antibiotic Dispensing in Community Pharmacy (Happy Patient Project)].

Plaza Zamora F, Mendoza Barbero A, Molinero A, Sanchez Marcos N, Lambert M, Taxis K Farm Comunitarios. 2024; 15(4):26-36.

PMID: 39156980 PMC: 11326684. DOI: 10.33620/FC.2173-9218.(2023).28.

Improving healthcare professionals' interactions with patients to tackle antimicrobial resistance: a systematic review of interventions, barriers, and facilitators.

Ayorinde A, Ghosh I, Shaikh J, Adetunji V, Brown A, Jordan M Front Public Health. 2024; 12:1359790.

PMID: 38841670 PMC: 11150712. DOI: 10.3389/fpubh.2024.1359790.

Use of the FebriDx® host-response point-of-care test may reduce antibiotic use for respiratory tract infections in primary care: a mixed-methods feasibility study.

Wilcox C, Odeh N, Clark T, Muller I, Becque T, Todd A J Antimicrob Chemother. 2024; 79(6):1441-1449.

PMID: 38708643 PMC: 11144485. DOI: 10.1093/jac/dkae127.

References

Smucny J, Fahey T, Becker L, Glazier R . Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2004; (4):CD000245. DOI: 10.1002/14651858.CD000245.pub2. View

Huddy J, Ni M, Mavroveli S, Barlow J, Williams D, Hanna G . A research protocol for developing a Point-Of-Care Key Evidence Tool 'POCKET': a checklist for multidimensional evidence reporting on point-of-care in vitro diagnostics. BMJ Open. 2015; 5(7):e007840. PMC: 4499707. DOI: 10.1136/bmjopen-2015-007840. View

Cals J, Butler C, Hopstaken R, Hood K, Dinant G . Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ. 2009; 338:b1374. PMC: 2677640. DOI: 10.1136/bmj.b1374. View

Butler C, Hood K, Verheij T, Little P, Melbye H, Nuttall J . Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ. 2009; 338:b2242. PMC: 3272656. DOI: 10.1136/bmj.b2242. View

Cals J, Chappin F, Hopstaken R, van Leeuwen M, Hood K, Butler C . C-reactive protein point-of-care testing for lower respiratory tract infections: a qualitative evaluation of experiences by GPs. Fam Pract. 2009; 27(2):212-8. DOI: 10.1093/fampra/cmp088. View

Kavanagh K, OShea E, Halloran R, Cantillon P, Murphy A . A pilot study of the use of near-patient C-Reactive Protein testing in the treatment of adult respiratory tract infections in one Irish general practice. BMC Fam Pract. 2011; 12:93. PMC: 3175160. DOI: 10.1186/1471-2296-12-93. View

Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M . Guidelines for the management of adult lower respiratory tract infections--full version. Clin Microbiol Infect. 2011; 17 Suppl 6:E1-59. PMC: 7128977. DOI: 10.1111/j.1469-0691.2011.03672.x. View

Wood F, Brookes-Howell L, Hood K, Cooper L, Verheij T, Goossens H . A multi-country qualitative study of clinicians' and patients' views on point of care tests for lower respiratory tract infection. Fam Pract. 2011; 28(6):661-9. DOI: 10.1093/fampra/cmr031. View

Latter S, Smith A, Blenkinsopp A, Nicholls P, Little P, Chapman S . Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of consultations. J Health Serv Res Policy. 2012; 17(3):149-56. DOI: 10.1258/JHSRP.2012.011090. View

10.

Verlee L, Verheij T, Hopstaken R, Prins J, Salome P, Bindels P . [Summary of NHG practice guideline 'Acute cough']. Ned Tijdschr Geneeskd. 2012; 156(0):A4188. View

11.

Little P, Stuart B, Moore M, Coenen S, Butler C, Godycki-Cwirko M . Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised, placebo-controlled trial. Lancet Infect Dis. 2012; 13(2):123-9. DOI: 10.1016/S1473-3099(12)70300-6. View

12.

Oppong R, Jit M, Smith R, Butler C, Melbye H, Molstad S . Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions. Br J Gen Pract. 2013; 63(612):e465-71. PMC: 3693803. DOI: 10.3399/bjgp13X669185. View

13.

Jones C, Howick J, Roberts N, Price C, Heneghan C, Pluddemann A . Primary care clinicians' attitudes towards point-of-care blood testing: a systematic review of qualitative studies. BMC Fam Pract. 2013; 14:117. PMC: 3751354. DOI: 10.1186/1471-2296-14-117. View

14.

Majeed A . General practice in the United Kingdom: meeting the challenges of the early 21st century. J R Soc Med. 2013; 106(10):384-5. PMC: 3791097. DOI: 10.1177/0141076813504326. View

15.

Little P, Stuart B, Francis N, Douglas E, Tonkin-Crine S, Anthierens S . Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet. 2013; 382(9899):1175-82. PMC: 3807804. DOI: 10.1016/S0140-6736(13)60994-0. View

16.

Huang Y, Chen R, Wu T, Wei X, Guo A . Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies. Br J Gen Pract. 2013; 63(616):e787-94. PMC: 3809432. DOI: 10.3399/bjgp13X674477. View

17.

Howick J, Cals J, Jones C, Price C, Pluddemann A, Heneghan C . Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA. BMJ Open. 2014; 4(8):e005611. PMC: 4127935. DOI: 10.1136/bmjopen-2014-005611. View

18.

Aabenhus R, Jensen J, Jorgensen K, Hrobjartsson A, Bjerrum L . Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database Syst Rev. 2014; (11):CD010130. DOI: 10.1002/14651858.CD010130.pub2. View

19.

Hunter R . Cost-effectiveness of point-of-care C-reactive protein tests for respiratory tract infection in primary care in England. Adv Ther. 2015; 32(1):69-85. PMC: 4311066. DOI: 10.1007/s12325-015-0180-x. View

20.

Anthierens S, Tonkin-Crine S, Cals J, Coenen S, Yardley L, Brookes-Howell L . Clinicians' views and experiences of interventions to enhance the quality of antibiotic prescribing for acute respiratory tract infections. J Gen Intern Med. 2014; 30(4):408-16. PMC: 4370987. DOI: 10.1007/s11606-014-3076-6. View