C-reactive protein diagnostic test uptake in primary care: a qualitative study of the UK's 2019-2024 AMR National Action Plan and lessons learnt from Sweden, the Netherlands and British Columbia.

objectivesThis study compares the implementation of C-reactive Protein (CRP) testing to distinguish between acute bacterial and viral infections in primary care in three WHO European region countries (Sweden, the Netherlands and the UK) and one WHO Americas region country (Canada) to generate insights that health services can use to guide decision-making on CRP test implementation.

settingThree settings were included: (1) national-level policy interviewees in England, (2) front-line antibiotic prescribers operating in primary care in England and (3) national-level policy interviewees in Canada, Sweden and the Netherlands.

participantsWe conducted in-depth qualitative interviews with 35 UK antimicrobial resistance policy-makers, clinicians and allied medical professionals. We also interviewed 13 national-level diagnostic test experts in Canada, Sweden, the Netherlands and the UK. We transcribed, thematically coded and analysed the data, using the NASSS framework for analysing technology-supported healthcare change.

resultsThere were multiple barriers and facilitators to CRP test implementation. The Netherlands was seen as the country with the most successful implementation of CRP, with enabling IT, financing and quality assurance infrastructure alongside strong guideline adherence to prevent overtesting. By contrast, Swedish interviewees reported 'CRP-itis', or widespread, guideline-discordant testing. UK uptake, contingent on local-level commissioning, has stalled amid mixed professional views. Canadian professional views are sceptical, and uptake plans are nearly non-existent. The NASSS themes emerging as the strongest facilitator or barrier to diagnostic uptake were the organisation and wider systems, with some reflections emerging on the limitations of NASSS to capture interface issues emerging from the analysis.

conclusionsHealth services considering CRP test adoption in primary care need to be mindful that, where concerns about the value proposition of the technology exist among policy-makers and professionals, CRPs are unlikely to be implemented; where there are discordant practices between policymakers/guidelines and clinicians, adoption of CRP testing may increase both antibiotic prescribing and costs to the health system. Where there is local-level commissioning of diagnostic tests, uptake may stagnate; and where implementation succeeds, it may be to the detriment of the public purse.