C-Reactive Protein-guided antibiotic prescribing for COPD exacerbations: a qualitative evaluation
Butler, Christopher C.
Royal College of General Practitioners
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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.
British Journal of General Practice;
Phillips, R., Stanton, H., Singh-Mehta, A., Gillespie, D., Bates, J., Gal, M., Thomas-Jones, E., Lowe, R., Hood, K., Llor, C., Melbye, H., Cals, J., White, P., Butler, C. and Francis, N. (2020) 'C-Reactive Protein-guided antibiotic prescribing for COPD exacerbations: a qualitative evaluation', British Journal of General Practice.
Article published in British Journal of General Practice on 18 May 2020, available open access at: https://doi.org/10.3399/bjgp20X709865.
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
The PACE study was funded by the NIHR Health Technology Assessment Program (project number 12/33/12).
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 UK Clinical Research Collaboration (UKCRC) registered University of Oxford Primary Care and Vaccines Clinical Trials Consortium.
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