Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford OX3 7FZ, UK; CABDyN Complexity Centre, Saïd Business School, University of Oxford, Park End Street, Oxford OX1 1HP, UK; Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, UK; Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 3/F, 60th Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok, Thailand.
Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 3/F, 60th Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok, Thailand.
Soc Sci Med. 2018 Apr;202:1-12. doi: 10.1016/j.socscimed.2018.02.018. Epub 2018 Feb 23.
New and affordable point-of-care testing (POCT) solutions are hoped to guide antibiotic prescription and to help limit antimicrobial resistance (AMR)-especially in low- and middle-income countries where resource constraints often prevent extensive diagnostic testing. Anthropological and sociological research has illuminated the role and impact of rapid point-of-care malaria testing. This paper expands our knowledge about the social implications of non-malarial POCT, using the case study of a C-reactive-protein point-of-care testing (CRP POCT) clinical trial with febrile patients at primary-care-level health centres in Chiang Rai province, northern Thailand. We investigate the social role of CRP POCT through its interactions with (a) the healthcare workers who use it, (b) the patients whose routine care is affected by the test, and (c) the existing patient-health system linkages that might resonate or interfere with CRP POCT. We conduct a thematic analysis of data from 58 purposively sampled pre- and post-intervention patients and healthcare workers in August 2016 and May 2017. We find widespread positive attitudes towards the test among patients and healthcare workers. Patients' views are influenced by an understanding of CRP POCT as a comprehensive blood test that provides specific diagnosis and that corresponds to notions of good care. Healthcare workers use the test to support their negotiations with patients but also to legitimise ethical decisions in an increasingly restrictive antibiotic policy environment. We hypothesise that CRP POCT could entail greater patient adherence to recommended antibiotic treatment, but it could also encourage riskier health behaviour and entail potentially adverse equity implications for patients across generations and socioeconomic strata. Our empirical findings inform the clinical literature on increasingly propagated point-of-care biomarker tests to guide antibiotic prescriptions, and we contribute to the anthropological and sociological literature through a novel conceptualisation of the patient-health system interface as an activity space into which biomarker testing is introduced.
新的、负担得起的即时检测（POCT）解决方案有望指导抗生素处方，并帮助限制抗生素耐药性（AMR）——尤其是在资源有限的低收入和中等收入国家，这些国家往往无法进行广泛的诊断检测。人类学和社会学研究阐明了即时疟疾检测的作用和影响。本文通过对泰国北部清莱府基层医疗中心发热患者进行 C 反应蛋白即时检测（CRP POCT）临床试验的案例研究，扩展了我们对非疟疾 POCT 的社会影响的认识。我们通过 CRP POCT 与（a）使用它的医护人员、（b）其常规护理受到检测影响的患者以及（c）可能与 CRP POCT 产生共鸣或干扰的现有患者-健康系统联系，来研究 CRP POCT 的社会作用。我们对 2016 年 8 月和 2017 年 5 月期间 58 名有针对性抽样的干预前后患者和医护人员进行了主题分析。我们发现患者和医护人员对该检测的普遍持积极态度。患者的观点受到 CRP POCT 的理解的影响，认为它是一种提供全面血液检测、具体诊断且符合优质护理概念的检测。医护人员使用该检测来支持与患者的谈判，同时也在日益受限的抗生素政策环境中为伦理决策提供合法性。我们假设 CRP POCT 可能会使患者更愿意接受推荐的抗生素治疗，但也可能会鼓励更危险的健康行为，并对不同代际和社会经济阶层的患者产生潜在的不利公平影响。我们的实证发现为越来越多的即时传播的生物标志物检测指导抗生素处方的临床文献提供了信息，并且通过将患者-健康系统接口概念化为引入生物标志物检测的活动空间，为人类学和社会学文献做出了贡献。
