Professionals’ views on using point-of-care CRP testing and delayed antibiotic prescriptions: a focus group study in high antibiotic prescribing general practices

Problem

Clinical trials have shown that the use of point-of-care (POC) C-reactive protein (CRP) tests and delayed/back-up prescriptions are effective strategies to reduce antibiotic use for self-limiting respiratory tract infections in primary care. These strategies may be particularly helpful to (further) reduce antibiotic use in general practices that remain high-prescribers of antibiotics. However, the implementation and routine use of both of these strategies in England remains low. This study aimed to explore the views of professionals from high antibiotic prescribing general practices on the use of these strategies, including barriers and facilitators influencing their uptake.

Approach

This was a qualitative study. The 20% (139) highest antibiotic prescribing practices in the West Midlands, England, were selected and invited to a focus group. Focus groups were conducted in practices by two researchers, were audio-recorded and transcribed verbatim. The transcripts were coded in NVivo and analysed using thematic analysis.

Findings

Nine practices participated with 50 professionals (3-11 per practice), including 30 GPs, 2 nurse prescribers, 1 pharmacist prescriber and 17 other staff (e.g. healthcare assistants, receptionists). The focus groups were between 50 and 90 (mean 70) minutes. The key findings included: (1) Tensions between professional role and CRP testing; prescribers reported clinical judgment (based on holistic examination and history) as central to their role, training and experience. Thus, they were unclear how POC CRP testing fits in the routine primary care consultations. They were also unsure when and how to use POC CRP testing. (2) Influences on using delayed antibiotic prescriptions; these included practice context (e.g., rural, dispensing practice), perceptions of a purpose of delayed prescriptions (e.g., safety-netting), and beliefs about how patients use them. (3) Professionals perceived both strategies as potentially helpful tools to negotiate treatment decisions with patients and help maintain patient satisfaction. (4) They reported ambivalent views about usefulness of these strategies in reducing antibiotic use, and were concerned about potential negative consequences (e.g., increasing patient expectation for CRP tests or delayed prescriptions, consultations, costs).

Consequences

Addressing barriers to, and concerns about, using POC CRP testing and delayed antibiotic prescriptions may help increase uptake of these strategies and optimise antibiotic use. These findings were used to inform development of resources to support the implementation and use of these strategies in high antibiotic prescribing general practices.