Evaluation of the implementation process of POC-CRP devices in managing adults with cough in general practice: insights from a focus group study.

BACKGROUND

Although acute respiratory tract infections are typically self-limiting, general practitioners (GPs) frequently prescribe antibiotics. C-reactive protein (CRP) point-of-care testing (POCT) has been shown to significantly reduce antibiotic prescribing and is cost-effective for adults with acute cough. However, before nationwide implementation in Belgium, organizational barriers must be addressed. AIM: to explore GPs’ experiences in a pilot project, using POC-CRP devices in general practice for adults with acute cough.

METHODS

Following a national CRP POCT pilot study, four multidisciplinary, semi-structured focus groups were conducted with 32 Belgian GPs and relevant stakeholders, whose role was limited to offering technical clarification when needed. Transcripts were analyzed using reflexive thematic analysis.

RESULTS

Across four focus groups, we identified four overarching themes. i. Reduced diagnostic uncertainty: CRP POCT is used as an objective tool to guide clinical decisions in cases of diagnostic uncertainty and to manage patient expectations. Doctors highlighted its usefulness across various conditions, especially in children. ii. Seamless integration with reliable support: The test was well integrated into routines, with GPs multitasking during the short waiting time. The device’s speed, simplicity, and small blood sample volume were crucial. GPs stressed the need for robust quality control and manufacturer support. iii. Facilitated decision making and patient communication: CRP POCT, used in addition to clinical judgment, supported clinical decisions, seemed to reduce unnecessary antibiotics, and reassured both doctors and patients. It also encouraged peer consultations when results were unclear. iv. Financial and reimbursement concerns: High test costs and lack of reimbursement remain key barriers to wider adoption.

CONCLUSIONS

Findings suggest that the tailored implementation of CRP POCT in Belgium can be effective if key aspects such as ease of use, seamless workflow integration, and decision-making support are prioritized. This approach aims to reduce inappropriate antibiotic prescribing and support antimicrobial stewardship efforts.