title: 'I'm fishing really'--inflammatory marker testing in primary care: a qualitative study.
abstract: BACKGROUND
  Inflammatory markers can be helpful as part of the diagnostic workup for specific diseases or for monitoring disease activity. A third use is as a screening and/or triage tool to differentiate between the presence or absence of disease. Most research into inflammatory markers looks at diagnosis of specific diseases and comes from secondary care. Qualitative studies to explore when and why clinicians use these tests in primary care are lacking.
  
  
  OBJECTIVE
  To identify clinicians' approaches to inflammatory marker testing in primary care.
  
  
  METHODS
  Qualitative study with 26 GPs and nurse practitioners.
  
  
  METHODS
  Interviews were conducted using a semi-structured topic guide. Clinicians reviewed recent cases of inflammatory marker testing in their pathology inbox. Interviews were audiorecorded and transcribed. Qualitative analysis was conducted by two of the authors.
  
  
  RESULTS
  Clinicians are uncertain about the appropriate use of inflammatory markers and differ in their approach to testing patients with undifferentiated symptoms. Normal or significantly elevated inflammatory markers are seen as helpful, but mildly raised inflammatory markers in the context of non-specific symptoms are difficult to interpret. Clinicians describe a tension between not wanting to 'miss anything' and, on the other hand, being wary of picking up borderline abnormalities that can lead to cascades of further tests. Diagnostic uncertainty is a common reason for inflammatory marker testing, with the aim to reassure; however, paradoxically, inconclusive results can generate a cycle of uncertainty and anxiety.
  
  
  CONCLUSIONS
  Further research is needed to define when inflammatory marker testing is useful in primary care and how to interpret results.
authors: Professor in primary health care, Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol.
authors: Jessica
authors: J
authors: Watson
authors: Professor in primary health care, Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol.
authors: Isabel
authors: I
authors: de Salis
authors: Professor of primary care diagnostics, University of Exeter Medical School, Exeter.
authors: Willie
authors: W
authors: Hamilton
authors: Professor in primary health care, Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol.
authors: Chris
authors: C
authors: Salisbury
mesh_terms: D001291:Attitude of Health Personnel; D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D058005:General Practitioners; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008297:Male; D009722:Nurse Practitioners; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods; D036301:Qualitative Research; D012017:Referral and Consultation; D012196:Review Literature as Topic; D035501:Uncertainty; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D015415:Biomarkers
keywords: C-reactive protein; acute-phase proteins; diagnosis; general practice; primary health care; qualitative research