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Qualitative study of primary care clinicians’ views on point-of-care testing for C-reactive protein for acute respiratory tract infections in family medicine
  1. Victoria Hardy1,
  2. Matthew Thompson1,
  3. Gina A Keppel1,
  4. William Alto2,
  5. M Ashworth Dirac3,
  6. Jon Neher4,
  7. Christopher Sanford1,
  8. Jaime Hornecker5,
  9. Allison Cole1
  1. 1Department of Family Medicine, University of Washington, Seattle, Washington, USA
  2. 2Seattle Indian Health Board, Seattle, Washington, USA
  3. 3Swedish Family Medicine First Hill, Seattle, Washington, USA
  4. 4Valley Family Medicine, Renton, Washington, USA
  5. 5Family Medicine Residency, University of Wyoming, Casper, Wyoming, USA
  1. Correspondence to Victoria Hardy; vhardy4{at}uw.edu

Abstract

Objective To explore clinicians views of the barriers and facilitators to use of C-reactive protein (CRP) point-of-care tests (POCT) in US family medicine clinics for the management of acute respiratory tract infections (ARTIs) in adults.

Setting Five family medicine clinics across two US states.

Participants 30 clinicians including 18 physicians, 9 physician residents, 2 physician assistants and 1 nurse practitioner, took part in the study.

Design A qualitative study using a grounded theory approach to thematically analyse focus group interviews.

Results These clinicians had limited access to diagnostic tests for patients with ARTI, and very little knowledge of CRP POCT. Three major themes were identified and included the potential clinical role of CRP POCT, concerns related to implementing CRP POCT and evidence needed prior to wider adoption in family medicine. Clinicians believed CRP POCT could support decision-making for some presentations of ARTIs and patient populations when used in conjunction with clinical criteria. Clinicians had concerns about possible overuse and inaccuracy of CRP POCT which they believed might increase antibiotic prescribing rates. Other concerns identified included integration of the test with clinic workflows and cost-effectiveness.

Conclusions Clinicians stand at the forefront of antibiotic stewardship efforts, but have few diagnostic tests to help them confidently manage ARTIs. CRP POCT may facilitate some aspects of clinical practice. Incorporating CRP POCT with clinical guidelines may strengthen utility of this test, when there is diagnostic uncertainty.

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Footnotes

  • Contributors MT conceived and designed the study; MT and VH collected the data; VH and MT analysed the data. VH drafted and MT revised the manuscript. GAK, MAD, WA, JN and CS contributed to development of the manuscript. All authors reviewed and commented on the manuscript.

  • Funding Alere Inc.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders of this study or of the National Institutes of Health.

  • Competing interests MT has received funding from Roche Molecular Diagnostics for consultancy work, and funding from the Patient-Centered Outcomes Research Institute for research on diagnostic test methods. The other authors declare no competing interests.

  • Ethics approval University of Washington Human Subject’s Division.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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