title: Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care: a qualitative study of barriers and facilitators to adoption.
abstract: OBJECTIVE
  Point-of-care (POC) C reactive protein (CRP) is incorporated in National Institute of Health and Care Excellence (NICE) guidelines for the diagnosis of pneumonia, reduces antibiotic prescribing and is cost effective.
  
  
  OBJECTIVE
  To determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary care for the diagnosis of lower respiratory tract infection.
  
  
  METHODS
  The study followed a qualitative methodology based on grounded theory. The study was undertaken in 2 stages. Stage 1 consisted of semistructured interviews with 8 clinicians from Europe and the UK who use the test in routine practice, and focused on their subjective experience in the challenges of implementing POC CRP testing. Stage 2 was a multidisciplinary-facilitated workshop with NHS stakeholders to discuss barriers to adoption, impact of adoption and potential adoption scenarios. Emergent theme analysis was undertaken.
  
  
  METHODS
  Participants included general practitioners (including those with commissioning experience), biochemists, pharmacists, clinical laboratory scientists and industry representatives from the UK and abroad.
  
  
  RESULTS
  Barriers to the implementation of POC CRP exist, but successful adoption has been demonstrated abroad. Analysis highlighted 7 themes: reimbursement and incentivisation, quality control and training, laboratory services, practitioner attitudes and experiences, effects on clinic flow and workload, use in pharmacy and gaps in evidence.
  
  
  CONCLUSIONS
  Successful adoption models from the UK and abroad demonstrate a distinctive pattern and involve collaboration with central laboratory services. Incorporating antimicrobial stewardship into quality improvement frameworks may incentivise adoption. Further research is needed to develop scaling-up strategies to address the resourcing, clinical governance and economic impact of widespread NHS implementation.
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Huddy
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: Melody Z
authors.initials: MZ
authors.lastname: Ni
authors.affiliation: Imperial College Business School, South Kensington Campus, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Barlow
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Azeem
authors.identifier: http://orcid.org/0000-0002-2357-9858
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
mesh_terms: D002097:C-Reactive Protein / Q000032:analysis*; D003362:Cost-Benefit Analysis; D005060:Europe; D006282:Health Personnel / Q000193:education*; D006801:Humans; D057970:Inappropriate Prescribing; D007407:Interviews as Topic; D009313:National Health Programs; D000067716:Point-of-Care Testing / Q000191:economics*; D011320:Primary Health Care / Q000592:standards*; D036301:Qualitative Research; D012141:Respiratory Tract Infections / Q000175:diagnosis*; D006113:United Kingdom
chemical_list: D002097:C-Reactive Protein
keywords: PRIMARY CARE; QUALITATIVE RESEARCH