Original Study
Implementation and Use of Point-of-Care C-Reactive Protein Testing in Nursing Homes

https://doi.org/10.1016/j.jamda.2021.09.010Get rights and content
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Abstract

Objectives

This study evaluated logistics, process data, and barriers/facilitators for the implementation and use of C-reactive protein point-of-care testing (CRP POCT) for suspected lower respiratory tract infections (LRTIs) in nursing home (NH) residents.

Design

This process evaluation was performed alongside a cluster randomized, controlled trial (UPCARE study) to evaluate the effect of CRP POCT on antibiotic prescribing for suspected LRTIs in NH residents.

Setting and Participants

Eleven NHs in the Netherlands.

Methods

Data sources for process data regarding intervention quality included a questionnaire among NH staff, logs, reports, and CRP POCT-analyzer records. Barriers and facilitators for implementation were assessed in focus group interviews with physicians and nurses from 3 NHs.

Results

Correct patient selection for CRP POCT and generally continued CRP POCT use indicated good fidelity. The initial training and training of new employees seemed to fit the need, but some POCT-user group sizes had increased over time, which could have impeded frequent use. Users were generally satisfied with CRP POCT and perceived its use feasible and relevant. Facilitators for implementation were initial commitment and active initiation, followed by continued attention and enthusiasm for building routine practice and trust. Short lines of communication between staff, short distance to the POCT-analyzer, 24/7 coverage of staff, and a clear task division facilitated continued attention and routine practice.

Conclusions and Implications

This process evaluation showed sufficient quality of providing CRP POCT in Dutch NHs. We processed findings of intervention quality and implementation knowledge into key recommendations for CRP POCT implementation in this setting. Future research could focus on CRP POCT use in countries with different organization of care in NHs.

Keywords

Process evaluation
antibiotic stewardship
C-reactive protein point-of-care testing
lower respiratory tract infection
nursing home

Cited by (0)

This work was supported The Netherlands Organization for Health Research and Development (ZonMw, program Antibiotic Resistance, grant number 541001 004).

LB reports a grant from The Netherlands Organization for Health Research and Development (ZonMw, program Antibiotic Resistance, grant number 541001 004), for the conduct of the current study. TB, FS, CH, RH and MT have no competing interests to disclose. TV reports grants from Abbott, Becton Dickinson, Biomerieux, European Commission, grants from European Commission, Orion, during the conduct of the study; grants from European Commission, Janssen Pharmaceuticals, grants from ZonMw, outside the submitted work. The Medical Ethical Committee of the VU University medical center in Amsterdam approved the trial protocol on March 28, 2018, as well as participation of all recruitment sites (NHs) in the trial. The trial was registered at the Netherlands Trial Register on 29 August 2018 with trial number NL5054. Orion Diagnostica and Saltro made in total 20 CRP POCT instruments available for the study.