C-Reactive Protein-guided antibiotic prescribing for COPD exacerbations: a qualitative evaluation

Abstract

Background: Antibiotics are prescribed to over 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 resulted in a 20% reduction in patient-reported antibiotic consumption over four weeks following consultations for AECOPD in primary care. Aim: To understand perceptions of the value of CRP-POCT for guiding antibiotic prescribing for AECOPD; explore possible mechanisms, mediators, and pathways through which the intervention had its 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’ decisions about prescribing antibiotics for AECOPD, and were positive aboutintroduction of the test in routine care. The CRP-POCT enhanced clinician confidencein antibiotic prescribing decisions, reduced decisional ambiguity, and facilitated communication with patients. Some 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. Conclusions: CRP-POCT guided antibiotic prescribing for AECOPD had high acceptability, but commissioning arrangements and further simplification of the point-of-care test need attention to facilitate implementation in routine practice.