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C-Reactive Protein-guided antibiotic prescribing for COPD exacerbations: a qualitative evaluation

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-e523. 10.3399/bjgp20X709865
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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Centre for Trials Research (CNTRR)
Publisher: Royal College of General Practitioners
ISSN: 0960-1643
Date of First Compliant Deposit: 6 January 2020
Date of Acceptance: 23 December 2019
Last Modified: 30 Aug 2020 16:04
URI: http://orca.cf.ac.uk/id/eprint/128246

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