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. 2023 Jun 16:12:e46938.
doi: 10.2196/46938.

The Impact of Point-of-Care Testing for Influenza on Antimicrobial Stewardship (PIAMS) in UK Primary Care: Protocol for a Mixed Methods Study

Uy Hoang  1 , Alice Williams  1 , Jessica Smylie  1 , Carole Aspden  1 , Elizabeth Button  1 , Jack Macartney  1 , Cecilia Okusi  1 , Rachel Byford  1 , Filipa Ferreira  1 , Meredith Leston  1 , Charis Xuan Xie  2 , Mark Joy  1 , Gemma Marsden  3 , Tristan Clark  4   5 , Simon de Lusignan  1
Affiliations

The Impact of Point-of-Care Testing for Influenza on Antimicrobial Stewardship (PIAMS) in UK Primary Care: Protocol for a Mixed Methods Study

Uy Hoang et al. JMIR Res Protoc. .

Abstract

Background: Molecular point-of-care testing (POCT) used in primary care can inform whether a patient presenting with an acute respiratory infection has influenza. A confirmed clinical diagnosis, particularly early in the disease, could inform better antimicrobial stewardship. Social distancing and lockdowns during the COVID-19 pandemic have disturbed previous patterns of influenza infections in 2021. However, data from samples taken in the last quarter of 2022 suggest that influenza represents 36% of sentinel network positive virology, compared with 24% for respiratory syncytial virus. Problems with integration into the clinical workflow is a known barrier to incorporating technology into routine care.

Objective: This study aims to report the impact of POCT for influenza on antimicrobial prescribing in primary care. We will additionally describe severe outcomes of infection (hospitalization and mortality) and how POCT is integrated into primary care workflows.

Methods: The impact of POCT for influenza on antimicrobial stewardship (PIAMS) in UK primary care is an observational study being conducted between December 2022 and May 2023 and involving 10 practices that contribute data to the English sentinel network. Up to 1000 people who present to participating practices with respiratory symptoms will be swabbed and tested with a rapid molecular POCT analyzer in the practice. Antimicrobial prescribing and other study outcomes will be collected by linking information from the POCT analyzer with data from the patient's computerized medical record. We will collect data on how POCT is incorporated into practice using data flow diagrams, unified modeling language use case diagrams, and Business Process Modeling Notation.

Results: We will present the crude and adjusted odds of antimicrobial prescribing (all antibiotics and antivirals) given a POCT diagnosis of influenza, stratifying by whether individuals have a respiratory or other relevant diagnosis (eg, bronchiectasis). We will also present the rates of hospital referrals and deaths related to influenza infection in PIAMS study practices compared with a set of matched practices in the sentinel network and the rest of the network. We will describe any difference in implementation models in terms of staff involved and workflow.

Conclusions: This study will generate data on the impact of POCT testing for influenza in primary care as well as help to inform about the feasibility of incorporating POCT into primary care workflows. It will inform the design of future larger studies about the effectiveness and cost-effectiveness of POCT to improve antimicrobial stewardship and any impact on severe outcomes.

International registered report identifier (irrid): DERR1-10.2196/46938.

Keywords: RSV; acute respiratory infection; antimicrobial; antimicrobial stewardship; general practice; health care; implementation; influenza; influenza point-of-care systems; medical records systems, computerized; outcome assessment; primary care; respiratory symptom.

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Conflict of interest statement

Conflicts of Interest: SdL is director of the Oxford Royal College of General Practitioners Research and Surveillance Centre. Through his university, he has received funding for vaccine-related research from AstraZeneca, GSK, Sanofi, Seqirus, and Takeda; he has been a member of advisory boards for AstraZeneca, Sanofi, and Seqirus. UH has undertaken continuing professional development podcasts funded by Seqirus and has been a member of advisory boards for Janssen. TC has received grant funding and/or equipment and consumables free of charge for the purposes of independent research from BioFire diagnostics, Biomerieux, QIAGEN and Sherlock Biosciences. They have received speaker fees, honoraria and travel re-imbursement from BioFire diagnostics, BioMerieux, QIAGEN and Janssen. TC has also received consultancy fees from BioMerieux, QIAGEN, Cepheid, Roche, Janssen and Synairgen research. TC has been a member of advisory boards for Cepheid, Roche, Janssen, Shiongi, Sanofi and Seqirus and acted as a member of independent data monitoring committees for trials sponsored by Roche and received remuneration at fair market value for these services. TS is also a member of an independent data monitoring committee for a Roche-sponsored study.

Figures

Figure 1
Figure 1
Swab positivity by week in the English national sentinel surveillance network from March 2022 to January 2023 [4]. hMPV: human metapneumovirus; RSV: respiratory syncytial virus.
See this image and copyright information in PMC

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