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The Impact of Point-of-Care Testing for Influenza on Antimicrobial Stewardship (PIAMS) in UK Primary Care: Protocol
Uy Hoang1, Alice Williams1, Jessica Smylie1
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
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.
Insights
Point-of-care testing (POCT) for influenza in primary care can guide antimicrobial prescribing. This study assesses POCT
Area of Science:
- Infectious Diseases
- Primary Care Medicine
- Health Informatics
Background:
- Molecular point-of-care testing (POCT) aids influenza diagnosis in primary care, potentially improving antimicrobial stewardship.
- Recent trends show influenza prevalence increasing, making rapid diagnostics crucial.
- Integrating new technologies into clinical workflows remains a challenge.
Purpose of the Study:
- To evaluate the impact of influenza POCT on antimicrobial prescribing in UK primary care.
- To describe severe infection outcomes, including hospitalization and mortality.
- To analyze the integration of POCT into primary care workflows.
Main Methods:
- An observational study involving 10 UK primary care practices from December 2022 to May 2023.
- Rapid molecular POCT for influenza on up to 1000 patients with respiratory symptoms.
- Linking POCT results with electronic health records and using process modeling for workflow analysis.
Main Results:
- Analysis of antimicrobial prescribing (antibiotics and antivirals) based on POCT influenza diagnosis.
- Comparison of hospitalization and mortality rates in study practices versus matched controls.
- Description of implementation models, including staff roles and workflow adaptations.
Conclusions:
- The study will provide data on the effectiveness of influenza POCT in primary care.
- Findings will inform the feasibility of integrating POCT into routine clinical practice.
- Results will guide future research on POCT's impact on antimicrobial stewardship and severe outcomes.
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