C-reactive protein-guided antibiotic prescribing for COPD exacerbations: A qualitative evaluation
AuthorPhillips, Rhiannon; Stanton, H.; Singh-Mehta, A.; Gillespie, David; Bates, Janine; Gal, Micaela; Thomas-Jones, Emma; Lowe, Rachel; Hood, Kerenza; Llor, Carl; Melbye, Hasse; Cals, Jochen; White, Patrick; Butler, Christopher C.; Francis, Nick
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.