Perception of the value of the CRP-POCT | General views of the CRP-POCT | Many felt that the CRP-POCT was a useful addition to the consultation that would help guide their doctor’s antibiotic prescribing decision. | Most thought the CRP-POCT was a useful addition to the consultation, particularly where there was diagnostic uncertainty. Clinicians emphasised the importance of using the CRP-POCT in addition to, not in place of, a thorough clinical assessment. |
|
Perceived mechanisms of impact of the CRP-POCT | Objective sign of illness | Patients felt that the CRP-POCT provided an objective sign of illness severity that could help guide treatment. | Prescribers felt that having this additional piece of objective evidence increased their confidence in their antibiotic prescribing decisions. |
Enhancing patient–clinician communication | CRP-POCT is useful in understanding whether antibiotics are needed, but there are some misconceptions about when antibiotics might or might not be helpful (for example, for viral infections). | Primary care staff felt that the test provided an opportunity to open discussions with patients about antibiotic use and antimicrobial resistance. |
Reinforcing prescribers’ decisions | Patients were generally passive in terms of making decisions about antibiotic treatment, with clinicians explaining their decision to/not to prescribe antibiotics to them. | Primary care staff perceived the CRP-POCT result as being useful in reinforcing their decision about antibiotic prescribing when communicating with patients. |
|
Implementation of the CRP-POCT | Views about implementation in routine practice | Many patients expressed positive attitudes towards the use of the CRP-POCT in routine NHS care for the management of AECOPD. | Positive attitudes towards the use of the CRP-POCT in routine NHS care, but there were differences of opinion about whether the CRP-POCT would be used for all patients with AECOPD, or only those where there was clinical uncertainty. |
Technical aspects of the test | Patients did not report any difficulties with the use of the CRP-POCT by clinicians. | Found the CRP-POCT easy to use, but felt that the need for test cartridges to be refrigerated during storage and returned to room temperature before use, need for regular calibration of the machine, and lack of portability of the device were potential barriers to widespread use in primary care. |
Time and resources | Patients felt that use of the test was quick and did not report any problems with the administration of the test. | Acknowledged the impact on consultation length that use of the CRP-POCT had, but felt that it was worthwhile. Felt that the cost of the CRP-POCT machine and cartridges was prohibitive under current funding arrangements. |
|
Contextual factors | Non-medical factors that influenced prescribing | Patient attitudes with regard to antibiotic use for AECOPD were varied, but many did not want to take antibiotics for AECOPD unless they were required. | Patient anxiety, a strong patient preference for antibiotics, and individual circumstances (for example, recent death of a spouse) were cited by primary care staff as reasons for still prescribing antibiotics despite a low CRP-POCT result. |