Johnson Matthew, Cross Liz, Sandison Nick, Stevenson Jamie, Monks Thomas, Moore Michael
NIHR CLAHRC Wessex Data Science Hub, Faculty of Health Sciences, University of Southampton, Southampton, UK.
Attenborough Surgery, Bushey Medical Centre, Herts Valleys Clinical Commissioning Group, NIHR CLARHC East of England, Bushey, UK.
BMJ Open. 2018 Oct 25;8(10):e024558. doi: 10.1136/bmjopen-2018-024558.
Utilisation of point-of-care C-reactive protein testing for lower respiratory tract infection has been limited in UK primary care, with costs and funding suggested as important barriers. We aimed to use existing National Health Service funding and policy mechanisms to alleviate these barriers and engage with clinicians and healthcare commissioners to encourage implementation.
A mixed-methods study design was adopted, including a qualitative survey to identify clinicians' and commissioners' perceived benefits, barriers and enablers post-implementation, and quantitative analysis of results from a real-world implementation study.
We developed a funding specification to underpin local reimbursement of general practices for test delivery based on an item of service payment. We also created training and administrative materials to facilitate implementation by reducing organisational burden. The implementation study provided intervention sites with a testing device and supplies, training and practical assistance.
Despite engagement with several groups, implementation and uptake of our funding specification were limited. Survey respondents confirmed costs and funding as important barriers in addition to physical and operational constraints and cited training and the value of a local champion as enablers.
Although survey respondents highlighted the clinical benefits, funding remains a barrier to implementation in UK primary care and appears not to be alleviated by the existing financial incentives available to commissioners. The potential to meet incentive targets using lower cost methods, a lack of policy consistency or competing financial pressures and commissioning programmes may be important determinants of local priorities. An implementation champion could help to catalyse support and overcome operational barriers at the local level, but widespread implementation is likely to require national policy change. Successful implementation may reproduce antibiotic prescribing reductions observed in research studies.
即时检测C反应蛋白用于下呼吸道感染在英国初级医疗保健中的应用有限，成本和资金被认为是重要障碍。我们旨在利用现有的国民医疗服务体系资金和政策机制来消除这些障碍，并与临床医生和医疗保健专员合作以鼓励实施。
采用混合方法研究设计，包括一项定性调查，以确定临床医生和专员在实施后所感知到的益处、障碍和促进因素，以及对一项实际实施研究结果的定量分析。
我们制定了一项资金规范，以支持基于服务项目付费的方式对提供检测的全科诊所进行本地报销。我们还创建了培训和管理材料，通过减轻组织负担来促进实施。实施研究为干预地点提供了检测设备和耗材、培训及实际协助。
尽管与多个群体进行了接触，但我们的资金规范的实施和采用情况有限。调查受访者确认，除了物理和操作方面的限制外，成本和资金也是重要障碍，并提到培训和当地倡导者的价值是促进因素。
尽管调查受访者强调了临床益处，但资金仍然是英国初级医疗保健实施的障碍，而且似乎并未因专员可获得的现有财政激励措施而得到缓解。使用低成本方法实现激励目标的可能性、缺乏政策一致性或相互竞争的财政压力以及委托项目可能是当地优先事项的重要决定因素。实施倡导者有助于在地方层面催化支持并克服操作障碍，但广泛实施可能需要国家政策变革。成功实施可能会重现研究中观察到的抗生素处方减少情况。
