The Potential Impact of Primary Care-Based Multiplex Polymerase Chain Reaction Point of Care Testing for Viral Acute Respiratory Infections in the UK: Modified Delphi Study.

Abstract

Background: Multiplex polymerase chain reaction (PCR) testing for viral acute respiratory infections (ARI) at the Point of Care (POC) has demonstrated clinical and economic value in secondary care, yet its impact in primary care remains uncertain. United Kingdom (UK) guidelines make conflicting recommendations on the use of testing in primary care settings.

Objectives: This study provides expert consensus on the potential clinical and economic implications of rapid PCR testing at the POC in primary care settings.

Design: A modified Delphi consensus panel approach was employed, with consensus statements developed from existing literature and evaluated through two rounds of questionnaires. Open-ended questions were posed to explore potential barriers to implementation, evidence generation, and suitable settings for testing.

Methods: A multistakeholder panel of 9 experts was purposely recruited, representing stakeholders from seven areas. A narrative literature review was conducted to generate consensus on the potential value of implementing rapid PCR testing at the POC for ARIs in primary care settings. Two Delphi rounds were completed, with participants rating their level of agreement with presented statements on a Likert scale from 1 to 5.

Results: Seventeen statements were generated based on the results of a narrative literature review, with eight achieving consensus and further evidence generation recommendations developed for six statements. Two statements were removed due to non-agreement and two were merged into a single statement, which later achieved consensus. The lack of cost and clinical effectiveness data was ranked as the greatest barrier to implementation. Primary care settings with high and low risk patients, such as general practices and care homes, were considered ideal for implementation.

Conclusion: There is potential value in rapid multiplex viral PCR testing for ARIs in primary care settings and care homes. While existing evidence and expert consensus indicate a likely benefit, further real-world evidence trials are recommended to evaluate the cost-effectiveness of this approach.