Inappropriate antimicrobial use is the most important modifiable risk factor for antimicrobial resistance (AmR), which is widely considered a global health threat, and is associated with significant morbidity, mortality, and costs. Most antimicrobial use occurs in primary care [prescribed by General Practitioners (GPs), dispensed by Community Pharmacists (CPs)]. However, up to 50% of use is deemed inappropriate. COVID-19 has changed the delivery of care in primary care, e.g. electronic transfer of prescriptions to pharmacies, fewer face-to-face consultations, and using diagnostic tests to rule out COVID-19 prior to face-to-face consultations with GPs.
This study aims to develop an intervention involving GPs and CPs to improve the use of point-of-care diagnostics in the management (diagnosis and treatment) of respiratory tract infections (RTIs) in primary care in Ireland. The objectives are to (i)develop best practice guidance (ii)explore perceived barriers and facilitators (GPs’ and CPs’ perspectives), (iii)determine patients’ views (iv)design an intervention and (v)test the intervention in a proof-of-concept study to improve the use of point-of-care diagnostics in primary care.
A systematic approach using the UK’s Medical Research Council’s guidance on complex intervention development will be followed. We will develop best practice guidance for using point-of-care diagnostics for RTIs and use this guidance to define target behaviour(s) for GPs and CPs. The domains within the Theoretical Domains Framework perceived to influence these behaviours will be identified and mapped to Behaviour Change Techniques (BCTs; the active ingredients). Draft interventions will be developed to operationalise each BCT, ensuring they are contextualised within the changed landscape of healthcare delivery in primary care in Ireland, and will be presented to a task group (involving GPs, CPs, patients, experts in point-of-care diagnostics and AmR) for discussion and feasibility assessment using APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity). The intervention will be tested in a proof-of-concept study.
