Integrating molecular point-of-care testing for influenza into primary care: a mixed-methods feasibility study
Integrating molecular point-of-care testing for influenza into primary care: a mixed-methods feasibility study
Background Molecular point-of-care testing (POCT) for influenza in primary care could influence clinical care and patient outcomes. Aim To assess the feasibility of incorporating influenza POCT into general practice in England. Design and setting A mixed-methods study conducted in six general practices that had not previously participated in respiratory virology sampling, which are part of the Royal College of General Practitioners Research and Surveillance Centre English sentinel surveillance network, from February 2019 to May 2019. Method A sociotechnical perspective was adopted using the Public Health England POCT implementation toolkit and business process modelling notation to inform qualitative analysis. Quantitative data were collected about the number of samples taken, their representativeness, and the virology results obtained, comparing them with the rest of the sentinel system over the same weeks. Results A total of 312 POCTs were performed; 276 were used for quantitative analysis, of which 60 were positive for influenza and 216 were negative. The average swabbing rate was 0.4 per 1000 population and swab positivity was between 16.7% (n = 14/84) and 41.4% (n = 12/29). Given a positive influenza POCT result, the odds ratio of receiving an antiviral was 14.1 (95% confidence intervals [CI] = 2.9 to 70.0, P<0.001) and of receiving an antibiotic was 0.4 (95% CI = 0.2 to 0.8, P = 0.01), compared with patients with a negative result. Qualitative analysis showed that it was feasible for practices to implement POCT, but there is considerable variation in the processes used. Conclusion Testing for influenza using POCT is feasible in primary care and may improve antimicrobial use. However, further evidence from randomised trials of influenza POCT in general practice is needed.
point-of-care (POC) diagnostics
555-562
Clark, Tristan
712ec18e-613c-45df-a013-c8a22834e14f
de Lusignan, Simon
ff8f6923-47a6-4c8e-8f12-c0517e6e3724
Hoang, Uy
011fb619-684e-4f4a-a6f7-3772376d664e
Liyanage, Harshana
28a7ebc4-00c8-4623-bb1b-99f004776cfc
Tripathy, Manasa
2c168494-e31f-42c3-8197-2e929f6ebe12
Yonova, Ivelina
af3dc379-05e8-48ac-9443-faa8e94dfb92
Byford, Rachel
431e02fe-f3bc-434d-a734-ed716b4e0e39
Ferreira, Filipa
f28c317a-ee8f-4754-9034-25ef7876207b
Diez-Domingo, Javier
b5798391-9f96-4b54-abf4-776fcfae7a21
August 2020
Clark, Tristan
712ec18e-613c-45df-a013-c8a22834e14f
de Lusignan, Simon
ff8f6923-47a6-4c8e-8f12-c0517e6e3724
Hoang, Uy
011fb619-684e-4f4a-a6f7-3772376d664e
Liyanage, Harshana
28a7ebc4-00c8-4623-bb1b-99f004776cfc
Tripathy, Manasa
2c168494-e31f-42c3-8197-2e929f6ebe12
Yonova, Ivelina
af3dc379-05e8-48ac-9443-faa8e94dfb92
Byford, Rachel
431e02fe-f3bc-434d-a734-ed716b4e0e39
Ferreira, Filipa
f28c317a-ee8f-4754-9034-25ef7876207b
Diez-Domingo, Javier
b5798391-9f96-4b54-abf4-776fcfae7a21
Clark, Tristan, de Lusignan, Simon, Hoang, Uy, Liyanage, Harshana, Tripathy, Manasa, Yonova, Ivelina, Byford, Rachel, Ferreira, Filipa and Diez-Domingo, Javier
(2020)
Integrating molecular point-of-care testing for influenza into primary care: a mixed-methods feasibility study.
The British journal of general practice : the journal of the Royal College of General Practitioners, 70 (697), .
(doi:10.3399/bjgp20X710897).
Abstract
Background Molecular point-of-care testing (POCT) for influenza in primary care could influence clinical care and patient outcomes. Aim To assess the feasibility of incorporating influenza POCT into general practice in England. Design and setting A mixed-methods study conducted in six general practices that had not previously participated in respiratory virology sampling, which are part of the Royal College of General Practitioners Research and Surveillance Centre English sentinel surveillance network, from February 2019 to May 2019. Method A sociotechnical perspective was adopted using the Public Health England POCT implementation toolkit and business process modelling notation to inform qualitative analysis. Quantitative data were collected about the number of samples taken, their representativeness, and the virology results obtained, comparing them with the rest of the sentinel system over the same weeks. Results A total of 312 POCTs were performed; 276 were used for quantitative analysis, of which 60 were positive for influenza and 216 were negative. The average swabbing rate was 0.4 per 1000 population and swab positivity was between 16.7% (n = 14/84) and 41.4% (n = 12/29). Given a positive influenza POCT result, the odds ratio of receiving an antiviral was 14.1 (95% confidence intervals [CI] = 2.9 to 70.0, P<0.001) and of receiving an antibiotic was 0.4 (95% CI = 0.2 to 0.8, P = 0.01), compared with patients with a negative result. Qualitative analysis showed that it was feasible for practices to implement POCT, but there is considerable variation in the processes used. Conclusion Testing for influenza using POCT is feasible in primary care and may improve antimicrobial use. However, further evidence from randomised trials of influenza POCT in general practice is needed.
Text
BJGP2020
- Version of Record
More information
Accepted/In Press date: 10 February 2020
Published date: August 2020
Additional Information:
Funding Information:
This study is part of Development of Robust and Innovative Vaccine Effectiveness (DRIVE), an EU-funded project, and part of the Innovative Medicines Initiative project (grant agreement number: 777363).
Funding Information:
Simon de Lusignan receives research funding from Eli Lilly Co., GlaxoSmithKline, Takeda, AstraZeneca, and Novo Nordisk Ltd. Tristan Clark has received speaker fees, honoraria, and equipment and consumables free of charge for the purposes of independent research from BioFire LLC and BioMerieux. Tristan Clark has also taken part in advisory board meetings for Roche and Janssen, and is a member of independent data-monitoring committees for trials sponsored by Roche. All other authors have declared no competing interests.
Copyright: The Authors
Keywords:
point-of-care (POC) diagnostics
Identifiers
Local EPrints ID: 443229
URI: http://eprints.soton.ac.uk/id/eprint/443229
ISSN: 0960-1643
PURE UUID: 7ddf09a8-e1c7-43c0-9093-398deb604509
Catalogue record
Date deposited: 18 Aug 2020 16:30
Last modified: 17 Mar 2024 03:34
Export record
Altmetrics
Contributors
Author:
Simon de Lusignan
Author:
Uy Hoang
Author:
Harshana Liyanage
Author:
Manasa Tripathy
Author:
Ivelina Yonova
Author:
Rachel Byford
Author:
Filipa Ferreira
Author:
Javier Diez-Domingo
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
