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

Abstract

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

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

Design and setting: A qualitative study was undertaken. The study was embedded in a multi-centre, individually randomised controlled efficacy trial, which evaluated the use of a multiplex RM POCT for suspected respiratory tract infections (RTIs) in primary care.

Method: Individual interviews were conducted with 18 clinicians (GPs, n = 9; advanced nurse practitioners, n = 4; paramedics, n = 2; trainee advanced nurse practitioner, n = 1; clinical pharmacist, n = 1; and emergency care practitioner, n = 1). Interviews were audio-recorded, transcribed verbatim, and analysed thematically informed by a realist approach.

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

Conclusion: The findings from this study highlight the potential benefits and challenges of integrating RM POCTs into routine practice. Clinicians in this study had generally favourable views towards RM POCTs. However, further RM POCT training, complementary strategies, such as communication skills training and patient education, and clear guidance on implementation should be explored to optimise RM POCT feasibility and outcomes across different primary care settings.

Keywords: antibiotics; diagnostics; point-of-care testing; primary health care; qualitative research; respiratory tract infections.