Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.
Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK.
Br J Gen Pract. 2020 Jun 25;70(696):e505-e513. doi: 10.3399/bjgp20X709865. Print 2020 Jul.
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.
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.
Qualitative process evaluation in UK general practices.
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.
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.
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.
在初级保健中，超过 70%的慢性阻塞性肺疾病（COPD）急性加重（AECOPD）患者会接受抗生素治疗。PACE 随机对照试验发现，在初级保健中使用 C 反应蛋白即时检测（CRP-POCT）管理策略治疗 AECOPD，可使患者在 4 周内报告的抗生素使用量减少 20%。
了解 CRP-POCT 对指导 AECOPD 抗生素治疗的价值的看法；探讨可能的机制、中介因素和作用途径；并从患者和临床医生的角度确定实施的潜在障碍和促进因素。
英国普通诊所的定性过程评估。
对 20 名 AECOPD 患者和 20 名初级保健工作人员进行半结构式电话访谈，这些患者和工作人员是从 PACE 研究中进行的有目的抽样。访谈进行了录音、转录，并使用框架分析进行了分析。
患者和临床医生认为 CRP-POCT 有助于指导临床医生对 AECOPD 进行抗生素治疗决策，并且对在常规护理中引入该检测持积极态度。CRP-POCT 增强了临床医生在抗生素治疗决策方面的信心，减少了决策的模糊性，并促进了与患者的沟通。一些临床医生认为 CRP-POCT 应在 AECOPD 咨询中常规使用；其他人则赞成只有在存在决策不确定性时才使用。CRP-POCT 试剂盒的准备时间和成本是实施的潜在障碍。
CRP-POCT 指导 AECOPD 的抗生素治疗具有较高的可接受性，但需要注意委托安排和进一步简化 CRP-POCT，以促进其在常规实践中的实施。
