@article{f83c7d3d6b024314a0afb2faea03091c,
title = "C-reactive protein-guided antibiotic prescribing for COPD exacerbations: a qualitative evaluation",
abstract = "BackgroundAntibiotics are prescribed to >70% of patients presenting in primary care with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The PACE randomised controlled trial found that a C-reactive protein point-of-care test (CRP-POCT) management strategy for AECOPD in primary care resulted in a 20% reduction in patient-reported antibiotic consumption over 4 weeks.AimTo understand perceptions of the value of CRP-POCT for guiding antibiotic prescribing for AECOPD; explore possible mechanisms, mediators. and pathways to effects; and identify potential barriers and facilitators to implementation from the perspectives of patients and clinicians.Design and settingQualitative process evaluation in UK general practices.MethodSemi structured telephone interviews with 20 patients presenting with an AECOPD and 20 primary care staff, purposively sampled from the PACE study. Interviews were audio-recorded, transcribed, and analysed using framework analysis.ResultsPatients and clinicians felt that CRP-POCT was useful in guiding clinicians' antibiotic prescribing decisions for AECOPD, and were positive about introduction of the test in routine care. The CRP-POCT enhanced clinician confidence in antibiotic prescribing decisions, reduced decisional ambiguity. and facilitated communication with patients. Seine clinicians thought the CRP-POCT should be routinely used in consultations for AECOPD; others favoured use only when there was decisional uncertainty. CRP-POCT cartridge preparation time and cost were potential barriers to implementation.ConclusionCRP-POCT guided antibiotic prescribing for AECOPD had high acceptability, but commissioning arrangements and further simplification of the CRP-POCT need attention to facilitate implementation in routine practice.",
keywords = "antibiotic, C-reactive protein, chronic obstructive pulmonary disease, point-of-care systems, primary health care, qualitative research, RESPIRATORY-TRACT INFECTIONS, CARE, EXPERIENCES, RESISTANCE, CLINICIAN, VIEWS, POINT",
author = "Rhiannon Phillips and Helen Stanton and Amina Singh-Mehta and David Gillespie and Janine Bates and Micaela Gal and Emma Thomas-Jones and Rachel Lowe and Kerenza Hood and Carl Llor and Hasse Melbye and Jochen Cals and Patrick White and Christopher Butler and Nick Francis",
note = "Funding Information: The PACE study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number: 12/33/12). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The work was undertaken with the support of the UK Clinical Research Collaboration (UKCRC)registered Centre for Trials Research, who receive infrastructure funding from Health and Care Research Wales and Cancer Research UK, and the UKCRC-registered University of Oxford Primary Care and Vaccines Clinical Trials Consortium. Neither the NIHR nor Health and Care Research Wales had a role in study design, data collection, data analysis, data interpretation, and report writing. The authors would like to thank all of those who have supported the PACE study, including the members of the PACE study research team, Trial Management Group, Trial Steering Committee, and Independent Data Monitoring and Ethics Committee, as well as the patients and primary healthcare staff who took part in these interviews for their time and for sharing their views. The authors would also like to acknowledge and thank the Health and Care Research Wales Workforce, the Thames Valley and South Midlands, Eastern, and West of England Primary Care Research Networks, and Comprehensive Local Clinical Research Networks for their support in recruiting sites for the PACE study. Funding Information: The PACE study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number: 12/33/12). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The work was undertaken with the support of the UK Clinical Research Collaboration (UKCRC)-registered Centre for Trials Research, who receive infrastructure funding from Health and Care Research Wales and Cancer Research UK, and the UKCRC-registered University of Oxford Primary Care and Vaccines Clinical Trials Consortium. Neither the NIHR nor Health and Care Research Wales had a role in study design, data collection, data analysis, data interpretation, and report writing. Funding Information: Rhiannon Phillips and Micaela Gal were research fellows at the Wales Centre for Primary and Emergency Research, Cardiff University, supported by a Research Centre Grant from Health and Care Research Wales during the completion of this study. Christopher Butler is an NIHR senior investigator, and clinical director of the University of Oxford Primary Care and Vaccines Clinical Trials Collaboration, and the NIHR Oxford Community Medical Technology and In Vitro Diagnostics Cooperative. Christopher Butler has received fees from Roche Diagnostics for participating in an Advisory Board about point-of-care testing; holds a grant from Roche Diagnostics to evaluate the analytic performance of a point-of-care testing device; and is part of publicly funded research consortia that include industrial partners. Jochen Cals is professor and primary care physician at the Department of Family Medicine at Maastricht University, and is supported by a Veni-grant (ref: 91614078) of the Netherlands Organization for Health Research and Development (ZonMw). Kerenza Hood is a Health and Care Research Wales senior investigator and director of the Centre for Trials Research. Acknowledgements The authors would like to thank all of those who have supported the PACE study, including the members of the PACE study research team, Trial Management Group, Trial Steering Committee, and Independent Data Monitoring and Ethics Committee, as well as the patients and primary healthcare staff who took part in these interviews for their time and for sharing their views. The authors would also like to acknowledge and thank the Health and Care Research Wales Workforce, the Thames Valley and South Midlands, Eastern, and West of England Primary Care Research Networks, and Comprehensive Local Clinical Research Networks for their support in recruiting sites for the PACE study. Open access This article is Open Access: CC BY-NC 4.0 licence (http://creativecommons.org/ licences/by-nc/4.0/). Publisher Copyright: {\textcopyright} The Authors This is the full-length article (published online 19 May 2020) of an abridged version published in print. Cite this version as: Br J Gen Pract 2020;",
year = "2020",
month = jul,
doi = "10.3399/bjgp20X709865",
language = "English",
volume = "70",
pages = "E505--E513",
journal = "British Journal of General Practice",
issn = "0960-1643",
publisher = "Royal College of General Practitioners",
number = "696",
}