C-reactive protein-guided antibiotic prescribing for COPD exacerbations: a qualitative evaluation

Rhiannon Phillips*, Helen Stanton, Amina Singh-Mehta, David Gillespie, Janine Bates, Micaela Gal, Emma Thomas-Jones, Rachel Lowe, Kerenza Hood, Carl Llor, Hasse Melbye, Jochen Cals, Patrick White, Christopher Butler, Nick Francis

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)

Abstract

Background

Antibiotics 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.

Aim

To 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 setting

Qualitative process evaluation in UK general practices.

Method

Semi 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.

Results

Patients 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.

Conclusion

CRP-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.

Original languageEnglish
Pages (from-to)E505-E513
Number of pages9
JournalBritish Journal of General Practice
Volume70
Issue number696
DOIs
Publication statusPublished - Jul 2020

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

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