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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
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
0960-1643
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
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, 679 (70), 555-562. (doi:10.3399/bjgp20X710897).

Record type: Article

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.

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Accepted/In Press date: 10 February 2020
Published date: 30 July 2020
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
ORCID for Tristan Clark: ORCID iD orcid.org/0000-0001-6026-5295

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Date deposited: 18 Aug 2020 16:30
Last modified: 28 Apr 2022 02:10

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Contributors

Author: Tristan Clark ORCID iD
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

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