Implementation of point-of-care tests in European primary care: a qualitative process evaluation with patients and clinicians in six countries

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

1A.2

Presenter:

Marta Wanat

Twitter:

@marta_wanat

Co-authors:

Marta Wanat1, Melanie Hoste2,3, Christopher Butler1, Alike van der Velden4, Sibyl Anthierens2, Sarah Tonkin-Crine1 on behalf of PRUDENCE trial

Author institutions:

1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK 2 Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium 3 Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium 4 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht,

Problem

Point-of-care tests (POCTs) are promoted for guiding antimicrobial prescribing for patients with community acquired acute respiratory tract infections (CA-RTI) in primary care because they may reduce uncertainty about the potential benefit of antibiotics for individual patients. The 10-country PRUDENCE trial is comparing prescribing and recovery outcomes for patients managed by clinicians in contrasting European settings with access to POC testing for C-reactive Protein, Influenza, STREP A and SARS-CoV-2 testing, compared to care without such testing.

Approach

We conducted an embedded process evaluation in Belgium, Ireland, Georgia, Germany, Greece, and UK involving semi-structured interviews with purposively sampled patients who consulted for CA-RTI in primary care, and the recruiting primary care clinicians. Data was analysed using thematic analysis, with triangulation of clinician and patient data.

Findings

: Interviews with 56 patients and 32 clinicians showed that POCT can be implemented within a GP consultation and all types of POCTs are acceptable to both patients and clinicians. Patients saw the value of POCTs as either supporting or as the main component in determining their treatment plan, and valued the rapid nature of tests. Clinicians varied in the extent they saw value in POCTs; those who saw value in POCTs highlighted the uncertainty in diagnosing RTIs, and thus felt that POCTs gave them more confidence in their decision making. Others felt that POCTs were not essential, yet felt reassured when the test results were aligned with their initial diagnosis. Across both groups of clinicians, misalignment between the test result(s) and the initial diagnosis/treatment decision prompted them to question these, which at times led to them changing their treatment decision, or to question the diagnostic value of the test. Patients views on specific types of POCTs did not seem to vary, but clinicians expressed preferences for certain types of tests (CRP, influenza, STREP A or SARS-CoV-2), depending on their local context and experience of using the tests.

Consequences

The study demonstrates that POCTs can be implemented in primary care settings for CA-ARI, with both patients and clinicians expressing overall acceptance of their use. While patients valued additional timely diagnostic information, for clinicians tests offered enhanced confidence in their decision making. Clinician preferences for specific types of POCTs highlight the importance of tailoring implementation of these tests to local contexts, clinician expertise and needs.

Submitted by:

Marta Wanat

Funding acknowledgement:

EU Horizon