C-reactive protein point of care testing in community pharmacy: Observational study of a Northern Ireland pilot

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Keywords

Point of care testing, C-reactive protein, Community pharmacy, Northern Ireland

Abstract

Background: Whether or not to prescribe an antibiotic is a key issue for clinicians treating respiratory tract infection (RTI) in the community. Measurement of C-reactive protein (CRP) in community pharmacy may help to differentiate viral and self-limiting infections from more serious bacterial infections. Objective: To pilot POC CRP testing for suspected RTI within community pharmacy in Northern Ireland (NI). Methods: POC CRP testing was piloted in 17 community pharmacies linked to 9 general practitioner (GP) practices in NI. The service was available to adults presenting to their community pharmacy with signs and symptoms of RTI. The pilot (between October 2019 and March 2020) was stopped early due to Coronavirus-19 (COVID-19). Results: During the pilot period, 328 patients from 9 GP practices completed a consultation. The majority (60%) were referred to the pharmacy from their GP and presented with <3 symptoms (55%) which had a duration of up to 1 week (36%). Most patients (72%) had a CRP result of <20mg/L. A larger proportion of patients with a CRP test result between 20mg/L and 100mg/L and >100mg/L, were referred to the GP when compared to patients with a CRP test result of <20mg/L. Antimicrobial prescribing rates were studied in a subgroup (n=30) from 1 practice. Whilst the majority (22/30; 73%) had a CRP test result of <20mg/L, 50%, (15/30) of patients had contact with the GP in relation to their acute cough and 43% (13/30) had an antibiotic prescribed within 5 days. The stakeholder and patient survey reported positive experiences. Conclusion: This pilot was successful in introducing POC CRP testing in keeping with National Institute of Health and Care Excellence (NICE) recommendations for the assessment of non-pneumonic lower RTIs and both stakeholders and patients reported positive experiences. A larger proportion of patients with a possible or likely bacterial infection as measured by CRP were referred to the GP, compared to patients with a normal CRP test result. Although stopped early due to COVID-19, the outcomes provide an insight and learning for the implementation, scale up and optimization of POC CRP testing in community pharmacy in NI.

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References

1. https://www.health-ni.gov.uk/news/nis-chief-medical-officer-warns-dangers-antibiotic-resistance 
2. https://www.daera-ni.gov.uk/publications/changing-culture-2019-2024-one-health
3. Acute lower respiratory tract infections (acute LRTI) statistics | British Lung Foundation (blf.org.uk)
4. World Health Organization. Global Action Plan on Antimicrobial Resistance, 2015.https://www.who.int/publications/i/item/9789241509763
5. Hay AD. Point-of-care tests to inform antibiotic prescribing. BMJ. 2021;374:n2253. https://doi.org/10.1136/bmj.n2253
6. NICE. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use, 2015. https://www.nice.org.uk/guidance/ng15.
7. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9:754.https://doi.org/10.3389/fimmu.2018.00754
8. Huddy JR, Ni MZ, Barlow J, et al. 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. BMJ Open. 2016;6:e009959. https://doi.org/10.1136/bmjopen-2015-009959
9. Cooke J, Llor C, Hopstaken R, et al. Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein(CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI. BMJ Open Respiratory Research. 2020;7:e000624. https://doi.org/10.1136/bmjresp-2020-000624 
10. https://www.nice.org.uk/guidance/cg191
11. https://www.england.nhs.uk/wp-content/uploads/2022/01/B0722-Point-of-Care-Testing-in-Community-Pharmacies-Guide_January-2022.pdf
12. Albasri A, Van den Bruel A, Hayward G, et al. Impact of point-of-care tests in community pharmacies: a systematic review and meta-analysis. BMJ Open. 2020;10:e034298. https://doi.org/10.1136/bmjopen-2019-034298
13. https://www.england.nhs.uk/primary-care/pharmacy/community-pharmacy-contractual-framework/
14. Dixon S, Fanshawe TR, Mwandigha L, et al. The Impact of Point-of-Care Blood C-Reactive Protein Testing on Prescribing
Antibiotics in Out-of-Hours Primary Care: A Mixed Methods Evaluation. Antibiotics (Basel). 2022;11(8):1008. https://doi.org/10.3390/antibiotics11081008
15. Boere TM, van Buul LW, Hopstaken RM, et al. Effect of C reactive protein point-of-care testing on antibiotic prescribing forlower respiratory tract infections in nursing home residents: cluster randomised controlled trial [published correction appears in BMJ. 2021 Nov 29;375:n2894]. BMJ. 2021;374:n2198. https://doi.org/10.1136/bmj.n2198
16. Little P, Stuart B, Francis N, et al. Antibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training: A Randomized Trial. Ann Fam Med. 2019;17(2):125-132. https://doi.org/10.1370/afm.2356

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