TY  - JOUR
AU  - Hoang, Uy
AU  - Williams, Alice
AU  - Smylie, Jessica
AU  - Aspden, Carole
AU  - Button, Elizabeth
AU  - Macartney, Jack
AU  - Okusi, Cecilia
AU  - Byford, Rachel
AU  - Ferreira, Filipa
AU  - Leston, Meredith
AU  - Xie, Charis Xuan
AU  - Joy, Mark
AU  - Marsden, Gemma
AU  - Clark, Tristan
AU  - de Lusignan, Simon
PY  - 2023
DA  - 2023/6/16
TI  - The Impact of Point-of-Care Testing for Influenza on Antimicrobial Stewardship (PIAMS) in UK Primary Care: Protocol for a Mixed Methods Study
JO  - JMIR Res Protoc
SP  - e46938
VL  - 12
KW  - medical records systems, computerized
KW  - influenza point-of-care systems
KW  - general practice
KW  - RSV
KW  - implementation
KW  - outcome assessment
KW  - health care
KW  - antimicrobial stewardship
KW  - acute respiratory infection
KW  - antimicrobial
KW  - influenza
KW  - primary care
KW  - respiratory symptom
AB  - 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 
SN  - 1929-0748
UR  - https://www.researchprotocols.org/2023/1/e46938
UR  - https://doi.org/10.2196/46938
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37327029
DO  - 10.2196/46938
ID  - info:doi/10.2196/46938
ER  -