Provider views on rapid diagnostic tests and antibiotic prescribing for respiratory tract infections: A mixed methods study

Abstract

Background Respiratory tract infections (RTIs) are often inappropriately treated with antibiotics. Rapid diagnostic tests (RDTs) have been developed with the aim of improving antibiotic prescribing but uptake remains low. The aim of this study was to examine provider knowledge, attitudes and behaviors regarding RDT use and their relationship to antibiotic prescribing decisions across multiple clinical departments in an urban safety-net hospital. Methods We conducted a mixed methods sequential explanatory study. Providers with prescribing authority (attending physicians, nurse practitioners and physician assistants) who had at least 20 RTI encounters from January 1, 2016 to December 31, 2018. Eighty-five providers completed surveys and 16 participated in interviews. We conducted electronic surveys via RedCap from April to July 2019, followed by semi-structured individual interviews from October to December 2019, to ascertain knowledge, attitudes and behaviors related to RDT use and antibiotic prescribing. Results Survey findings indicated that providers felt knowledgeable about antibiotic prescribing guidelines. They reported high familiarity with the rapid streptococcus and rapid influenza tests. Familiarity with comprehensive respiratory panel PCR (RPP-respiratory panel PCR) and procalcitonin differed by clinical department. Qualitative interviews identified four main themes: providers trust their clinical judgment more than rapid test results; patient-provider relationships play an important role in prescribing decisions; there is patient demand for antibiotics and providers employ different strategies to address the demand and providers do not believe RDTs are implemented with sufficient education or evidence for clinical practice. Conclusion Prescribers are knowledgeable about prescribing guidelines but often rely on clinical judgement to make final decisions. The utility of RDTs is specific to the type of RDT and the clinical department. Given the low familiarity and clinical utility of RPP and procalcitonin, providers may require additional education and these tests may need to be implemented differently based on clinical department.

Antimicrobial susceptibility testing: An updated primer for clinicians in the era of antimicrobial resistance: Insights from the Society of Infectious Diseases Pharmacists

“…Finally, proper education and communication are essential in this phase 71 . Evidence suggests that providers believe laboratory diagnostics are often implemented without sufficient education or evidence, leading to distrust and lack of use of new technologies including RDTs and AST 78 . Each step of the laboratory workflow, from processing to resulting, is considered to be within the analytic phase (Figure 2).…”

“…71 Evidence suggests that providers believe laboratory diagnostics are often implemented without sufficient education or evidence, leading to distrust and lack of use of new technologies including RDTs and AST. 78 Each step of the laboratory workflow, from processing to resulting, is considered to be within the analytic phase 81 The clinical value associated with advancing technology will rely on multidisciplinary collaboration for successful uptake and utilization. 79 Aligning antimicrobial stewardship with appropriate use of innovative diagnostic technologies will contribute to advancements in patient care and improvement in outcomes.…”

Primary Care Antibiotic Prescribing and Infection-Related Hospitalisation

“…Rapid diagnostic tests have been found to increase diagnostic accuracy, shorten hospital stays, and lower both mortality and healthcare costs when used in conjunction with antimicrobial stewardship [55]. However, there are several barriers that hinder the use of such tests, such as GPs' tendency to rely more on their own clinical judgement than the findings of a rapid test, patients' demands for antibiotics, the patient-provider relationship, and a lack of provider education or evidence regarding some rapid diagnostic tests and their proper application [59]. As a result, there is a need for implementation techniques that are multifaceted and address discrepancies between knowledge and behaviour, such as patient education and customized approaches for each rapid diagnostic test within different departments [59].…”

Diagnostic Stewardship as a Team Sport: Interdisciplinary Perspectives on Improved Implementation of Interventions and Effect Measurement

“…Understanding the impact of each of these factors at the local level is critical to the success of any laboratory-based stewardship intervention. In clinical practice, a recent survey highlights the variability in knowledge and opinion among hospitals and between departments within the same hospital [ 46 ]. Despite most clinicians stating that they feel knowledgeable about testing and treating guidelines, significant differences in opinion remain regarding the use of rapid respiratory diagnostics.…”

“…Despite most clinicians stating that they feel knowledgeable about testing and treating guidelines, significant differences in opinion remain regarding the use of rapid respiratory diagnostics. Ultimately, individual clinician confidence in decision making, familiarity with the diagnostic test, department, and the level of education clinicians receive about a test impacts the way a clinician interprets a rapid respiratory diagnostic result [ 46 ]. Without evaluating all the possible factors that could contribute to the success or failure of an intervention in the post-analytic phase of infectious disease diagnostics, the impact and sustainability of stewardship interventions are at risk of being less impactful.…”