PT  - JOURNAL ARTICLE
AU  - Rhiannon Phillips
AU  - Helen Stanton
AU  - Amina Singh-Mehta
AU  - David Gillespie
AU  - Janine Bates
AU  - Micaela Gal
AU  - Emma Thomas-Jones
AU  - Rachel Lowe
AU  - Kerenza Hood
AU  - Carl Llor
AU  - Hasse Melbye
AU  - Jochen Cals
AU  - Patrick White
AU  - Christopher Butler
AU  - Nick Francis
TI  - C-reactive protein-guided antibiotic prescribing for COPD exacerbations: a qualitative evaluation
AID  - 10.3399/bjgp20X709865
DP  - 2020 May 19
TA  - British Journal of General Practice
PG  - bjgp20X709865
4099  - http://bjgp.org/content/early/2020/05/18/bjgp20X709865.short
4100  - http://bjgp.org/content/early/2020/05/18/bjgp20X709865.full
AB  - 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.