C-reactive protein-guided antibiotic prescribing for COPD exacerbations: a qualitative evaluation.
C-reactive protein
antibiotic
chronic obstructive pulmonary disease
point-of-care systems
primary health care
qualitative research
Journal
The British journal of general practice : the journal of the Royal College of General Practitioners
ISSN: 1478-5242
Titre abrégé: Br J Gen Pract
Pays: England
ID NLM: 9005323
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
27
08
2019
accepted:
23
12
2019
pubmed:
20
5
2020
medline:
25
6
2021
entrez:
20
5
2020
Statut:
epublish
Résumé
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. 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. Qualitative process evaluation in UK general practices. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32424045
pii: bjgp20X709865
doi: 10.3399/bjgp20X709865
pmc: PMC7239040
doi:
Substances chimiques
Anti-Bacterial Agents
0
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e505-e513Subventions
Organisme : Department of Health
Pays : United Kingdom
Informations de copyright
©The Authors.
Références
Eur Respir J. 2010 Jun;35(6):1209-15
pubmed: 20513910
NPJ Prim Care Respir Med. 2014 Jul 17;24:14026
pubmed: 25030621
BMJ. 2006 Feb 18;332(7538):413-6
pubmed: 16484270
BMJ Open. 2017 Jan 25;7(1):e012503
pubmed: 28122829
Lancet. 2005 Feb 12-18;365(9459):579-87
pubmed: 15708101
BMJ Open. 2012 May 22;2(3):
pubmed: 22619265
BMJ. 2010 May 18;340:c2096
pubmed: 20483949
Adm Policy Ment Health. 2015 Sep;42(5):533-44
pubmed: 24193818
Am J Respir Crit Care Med. 2017 Mar 1;195(5):557-582
pubmed: 28128970
N Engl J Med. 2019 Jul 11;381(2):111-120
pubmed: 31291514
Fam Pract. 2011 Dec;28(6):661-9
pubmed: 21653924
BMJ. 2001 May 5;322(7294):1115-7
pubmed: 11337448
BMJ Open. 2016 Mar 03;6(3):e009959
pubmed: 26940107
J Gen Intern Med. 2015 Apr;30(4):408-16
pubmed: 25373834
Eur Respir J. 1999 Nov;14(5):1015-22
pubmed: 10596683
BMC Med Res Methodol. 2013 Sep 18;13:117
pubmed: 24047204
Trials. 2017 Sep 29;18(1):442
pubmed: 28969667
BMJ. 2015 Mar 19;350:h1258
pubmed: 25791983
Lancet Infect Dis. 2007 Nov;7(11):749-56
pubmed: 17961860
BMC Fam Pract. 2012 Oct 11;13:101
pubmed: 23110756
Am J Respir Crit Care Med. 2006 Oct 15;174(8):867-74
pubmed: 16799074
PLoS One. 2013 Oct 23;8(10):e76691
pubmed: 24194845
Implement Sci. 2009 Sep 08;4:57
pubmed: 19737382
Cochrane Database Syst Rev. 2012 Dec 12;12:CD010257
pubmed: 23235687
Ther Adv Respir Dis. 2013 Jun;7(3):131-7
pubmed: 23325784
Fam Pract. 2010 Apr;27(2):212-8
pubmed: 20022909
Lancet. 2013 Oct 5;382(9899):1175-82
pubmed: 23915885