The impact of point of care testing for influenza on antimicrobial stewardship (PIAMS) in UK primary care: mixed methods study protocol (Preprint)

BACKGROUND Molecular point-of-care testing (POCT) used in primary care can inform whether a patient presenting with an acute respiratory infection has influenza or respiratory syncytial virus (RSV). A confirmed clinical diagnosis, particularly early in the disease, could inform better antimicrobial stewardship, and the use of antiviral therapy. Social distancing and lockdowns during the COVID-19 pandemic have disturbed previous pattern of influenza and RSV infections. Data from samples taken in the last quarter of 2022, suggest these viruses represent 36% and 24% respectively of sentinel network positive virology; compared to 16% with COVID-19. Problems with integration into clinical workflow and unexpected consequences are two known barriers to incorporating technology into routine care. OBJECTIVE To report the impact of point of care testing for influenza and RSV on antibiotic and antiviral prescribing in primary care. We will additionally describe severe outcomes of infection (hospitalisation and mortality) and how POCT is integrated into primary care workflow. METHODS An observational study between December 2022-May 2023, involving ten practices that contribute data to the English sentinel network will take place. Up to 1,000 people who present to participating practices with respiratory symptoms will be swabbed and tested with a rapid molecular POCT analyser in the practice. Antimicrobial prescribing and other study outcomes will be collected by linking information from the POCT analyser with data from the patient’s computerised medical record(CMR). We will collect data on appointment length and report data flows and how POCT is incorporated into practice using data flow diagrams(DFD), unified modelling language(UML) use-case diagrams and business process modelling notation(BPMN). RESULTS We will present the crude and adjusted odds of antimicrobial prescribing given a POCT diagnosis of influenza, stratifying by whether individuals have a respiratory or other relevant diagnosis (e.g. bronchiectasis). We will also present the rates of hospital referrals and deaths related to respiratory 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. CLINICALTRIAL Not applicable