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

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

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. 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. 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.

Antibiotic, C-reactive protein, Chronic obstructive pulmonary disease, Point-of-care systems, Primary health care, Qualitative research
0960-1643
E505-E513
Phillips, Rhiannon
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Stanton, Helen
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Singh-Mehta, Amina
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Gillespie, David
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Bates, Janine
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Gal, Micaela
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Thomas-Jones, Emma
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Lowe, Rachel
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Hood, Kerenza
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Llor, Carl
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Melbye, Hasse
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Cals, Jochen
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White, Patrick
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Butler, Christopher
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Francis, Nick
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Phillips, Rhiannon
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Stanton, Helen
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Singh-Mehta, Amina
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Gillespie, David
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Bates, Janine
290a69e6-4f81-4dbe-b270-30e4155ca576
Gal, Micaela
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Thomas-Jones, Emma
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Lowe, Rachel
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Hood, Kerenza
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Llor, Carl
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Melbye, Hasse
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Cals, Jochen
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White, Patrick
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Butler, Christopher
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Francis, Nick
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Phillips, Rhiannon, Stanton, Helen, Singh-Mehta, Amina, Gillespie, David, Bates, Janine, Gal, Micaela, Thomas-Jones, Emma, Lowe, Rachel, Hood, Kerenza, Llor, Carl, Melbye, Hasse, Cals, Jochen, White, Patrick, Butler, Christopher and Francis, Nick (2020) C-reactive protein-guided antibiotic prescribing for COPD exacerbations: a qualitative evaluation. British Journal of General Practice, 70 (696), E505-E513. (doi:10.3399/bjgp20X709865).

Record type: Article

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. 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. 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.

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Accepted/In Press date: 23 December 2019
e-pub ahead of print date: 19 May 2020
Published date: July 2020
Additional Information: ©The Authors.
Keywords: Antibiotic, C-reactive protein, Chronic obstructive pulmonary disease, Point-of-care systems, Primary health care, Qualitative research

Identifiers

Local EPrints ID: 444673
URI: http://eprints.soton.ac.uk/id/eprint/444673
ISSN: 0960-1643
PURE UUID: a4ed8e0c-5ab9-4ceb-8180-b1ac92e86527
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312

Catalogue record

Date deposited: 29 Oct 2020 17:31
Last modified: 10 Jan 2022 03:19

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Contributors

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

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