Implementation of C-Reactive Protein Point-of-Care Testing for Respiratory Tract Infections in Primary Care: A Systematic Review Using the RE-AIM Framework.

BACKGROUND/

OBJECTIVES

C-reactive protein point-of-care tests (CRP POCTs) have become a useful tool in reducing inappropriate prescribing of antibiotics in the management of respiratory tract infections (RTIs). This review examined the barriers and enablers of CRP POCT implementation in primary care using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.

METHODS

A search was conducted in six electronic databases (PubMed, Scopus, CINAHL (EBSCOhost), Medline (EBSCOhost), ProQuest and CENTRAL) for studies up to December 2025 on CRP POCT implementation for RTIs in primary care. Eligible studies included quantitative randomised controlled trials (RCTs), qualitative studies, cost-effectiveness studies, mixed-methods and observational studies. Only English-language studies were included.

RESULTS

The review included 35 studies. CRP POCT was generally found to be an effective and acceptable tool due to reductions in antibiotic prescribing, playing a role in supporting clinical decision-making and patient communication. However, widespread adoption and usage were inconsistent across studies. Further, qualitative findings raised operational and financial constraints as key barriers to sustained implementation. Reporting of RE-AIM domains varied across study type. Notable gaps were identified in reporting of the maintenance domain along with population representativeness, non-participation, and device uptake. Of the 35 studies, 13 included 'operational' and/or 'financial constraints' as identified themes or concerns about wider implementation.

CONCLUSIONS

Although CRP POCT has routinely been found to be effective, a wider comprehensive assessment of implementation is restricted due to gaps in reporting. Key barriers to sustained and scalable global implementation of CRP POCT in primary care are predominantly financial and operational.