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

• Published in: British journal of general practice Vol. 70; no. 696; pp. e505 - e513
• Main Authors: 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, Francis, Nick
• Format: Journal Article
• Language: English
• Published: England Royal College of General Practitioners 01.07.2020
• Subjects: Antibiotics; Chronic obstructive pulmonary disease; Clinical trials; Community medicine, Social medicine: 801; Drug resistance; Health sciences: 800; Helsefag: 800; Medical disciplines: 700; Medisinske Fag: 700; Prescription drugs; Samfunnsmedisin, sosialmedisin: 801; VDP; antibiotic; primary health care; C-reactive protein; point-of-care systems; qualitative research; chronic obstructive pulmonary disease
• ISSN: 0960-1643; 1478-5242; 1478-5242
• DOI: 10.3399/bjgp20X709865

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.