Qualitative evaluation of a molecular point- of- care testing study for influenza in UK primary care

Background: Influenza contributes to the surge in winter infections and the consequent winter pressures on the health service. Molecular point- of- care testing (POCT) for influenza may improve patient management by providing rapid and accurate clinical diagnosis to inform the timely initiation of antiviral therapy and reduce unnecessary admissions and antibiotics use. Aim: To explore factors that influence the adoption or non- adoption of POCT in English general practices and provide insights to enable its integration into routine practice workflows. Design & setting: A qualitative implementation evaluation was conducted in 10 general practices within the English national sentinel network (Oxford RCGP Research and Surveillance Centre), from April-July 2023. Method: Using the Non- adoption, Abandonment, Scale- up, Spread, and Sustainability (NASSS) framework, data collection and analysis were conducted across 10 practices. We made ethnographic observations of the POCT workflow and surveyed the practice staff for their perspectives on POCT implementation. Data were analysed using a mix of descriptive statistics, graphical modelling techniques, and framework analysis. Results: Ethnographic observations identified the following two modes of POCT integration into practice workflow: (1) clinician POCT workflow, which typically involved batch testing owing to time constraints; and (2) research nurse or healthcare assistant POCT workflow, which was characterised by immediate testing of individual patients. Survey data indicated that most primary care staff considered the POCT training offered was sufficient and these practices were ready for change. Some participants agreed that there was the capacity and resources to integrate POCT into workflows. It was uncertain as to whether POCT required changes to organisational routines and processes. Conclusion: General practices should demonstrate flexibility in the workflow and workforce they deploy to integrate POCT into routine clinical workflow.