Rapid microbiological respiratory point-of-care-testing: a qualitative study with primary care clinicians.

Abstract

Background: Rapid microbiological point-of-care tests (POCTRM) present an opportunity to reduce antibiotic exposure and antimicrobial resistance. So far, there is limited understanding of how POCTRM may support clinicians in primary care in the UK and how POCTs might be integrated into practice.

Aim: To investigate clinicians' views on how POCTRM could influence clinical decisions and routine practice, and perspectives on how POCTRM may impact the clinician-patient relationship.

Design and setting: Qualitative study embedded in a multi-centre, individually randomised controlled efficacy trial evaluating the use of a multiplex POCTRM for suspected respiratory tract infections in primary care.

Method: Individual interviews were conducted with 18 clinicians (n= 9 General Practitioners, 4 Advanced Nurse Practitioners, 1 trainee Advanced Nurse Practitioner, 1 Clinical Pharmacist, 2 Paramedics, 1 Emergency Care Practitioner). Interviews were audio-recorded, transcribed verbatim and analysed thematically informed a realist approach.

Results: POCTRM can guide prescribing decisions when clinicians experience diagnostic uncertainty and support communication with patients to reinforce prescribing decisions. Consequently, the perceived value, and use of, POCTRM varied according to clinicians' confidence in making prescribing decisions and managing patient expectations and their clinical roles. The costly and time-consuming nature of POCTRM meant that integration of POCTRM into routine practice was considered unlikely at present.

Conclusion: Clinicians in this study had generally favourable views towards POCTRM, but further POCTRM training, complementary strategies such as communication skills training and patient education, and clear guidance on implementation should be explored to optimise POCTRM feasibility and outcomes across different primary care settings.