Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
Front Public Health. 2023 Jul 31;11:1216940. doi: 10.3389/fpubh.2023.1216940. eCollection 2023.
The majority of antibiotics are prescribed in primary care for respiratory tract infections. Point-of-care tests (POCTs) for the management of community-acquired acute respiratory tract infections (CA-ARTI) have been developed to help optimize antibiotic prescribing. While some countries in Europe have adopted these tests in primary care settings, most have not. Stakeholders, such as policy-makers, regulators, the diagnostic industry, and scientific associations, have roles in the implementation of new diagnostics in primary care. The aim of this study is to explore these stakeholders' views and experiences, and identify areas of unmet need relating to POCT implementation.
Stakeholders were recruited using purposive sampling and snowballing. Between March 2021 and May 2022, semi-structured interviews were conducted online with stakeholders in Belgium, the UK and from European Union (EU) -level organizations. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed inductively and deductively using thematic analysis.
Twenty-six stakeholders participated: eleven from EU-level organizations, seven from Belgium, and eight from the UK. Five themes were identified. Stakeholders felt a balance of top-down and bottom-up approaches were an optimal strategy to the implementation of POCTs. Stakeholders stressed the need to engage with clinicians to act as champions for tests to help raise awareness and generate new evidence on how tests are used. While acknowledging the potential of POCTs for improving patient outcomes and impacting antibiotic prescribing behavior, some raised concerns on how tests would be used in practice and wished to see national data on effectiveness. COVID-19 catalyzed the use of tests, but stakeholders were pessimistic that processes for approving diagnostics during the pandemic would be replicated in the future.
Stakeholders provided recommendations for research and practice. Robust reimbursement policies could alleviate financial burden from clinicians and patients, encouraging practices to adopt POCTs. Industry is likely to benefit from engaging as early on as possible with other stakeholders. Due to uncertainty among stakeholders on the impact of POCTs on antibiotic prescribing, further evidence is needed to understand how practices adopt POCTs and the implications for stewardship. Monitoring how POCTs are used can inform future guidelines on successful diagnostic implementation.
大多数抗生素都是在初级保健机构用于治疗呼吸道感染。为了帮助优化抗生素的使用，已经开发了用于管理社区获得性急性呼吸道感染（CA-ARTI）的即时检测（POCT）。虽然欧洲的一些国家已经在初级保健环境中采用了这些检测，但大多数国家还没有。政策制定者、监管机构、诊断行业和科学协会等利益相关者在初级保健中实施新诊断方面发挥作用。本研究的目的是探讨这些利益相关者的观点和经验，并确定与 POCT 实施相关的未满足需求领域。
使用目的抽样和滚雪球抽样招募利益相关者。2021 年 3 月至 2022 年 5 月，通过在线方式对来自比利时、英国和欧盟（EU）级组织的利益相关者进行了半结构化访谈。访谈进行了录音，并逐字记录。使用主题分析对转录本进行了归纳和演绎分析。
共有 26 位利益相关者参与：来自欧盟级组织的 11 位、来自比利时的 7 位和来自英国的 8 位。确定了五个主题。利益相关者认为自上而下和自下而上的方法相结合是实施 POCT 的最佳策略。利益相关者强调需要与临床医生合作，让他们成为检测的拥护者，以提高对检测使用方式的认识并产生新的证据。尽管承认 POCT 有可能改善患者的治疗效果并影响抗生素的使用行为，但一些人对检测在实践中的使用方式表示担忧，并希望看到有关检测有效性的国家数据。COVID-19 推动了检测的使用，但利益相关者对未来是否会复制大流行期间批准诊断的流程持悲观态度。
利益相关者为研究和实践提供了建议。稳健的报销政策可以减轻临床医生和患者的经济负担，鼓励医疗实践采用 POCT。行业可能会受益于尽早与其他利益相关者合作。由于利益相关者对 POCT 对抗生素使用的影响存在不确定性，因此需要进一步的证据来了解实践如何采用 POCT 以及对管理的影响。监测 POCT 的使用情况可以为成功实施诊断指南提供信息。
