Improving safety and TReatment precision for Acute COPD Exacerbations (TRACE): Feasibility of point-of-care blood testing in community pharmacies. A qualitative study of clinicians’ views

Abstract Background and aims Point-of-care blood tests (POCTs) have the potential to improve the targeted prescription of antibiotics and oral corticosteroids (OCS) for the treatment of acute chronic obstructive pulmonary disease (COPD) exacerbations (AECOPDs) in primary care. The ease of access to and key role of pharmacists in chronic disease management make siting the tests in community pharmacies an attractive proposition. This study aimed to explore the opinions of community pharmacists and general practitioners (GPs) on the feasibility and acceptability of a new POCT-based AECOPD pathway in pharmacies. Methods Semi-structured interviews with clinicians (pharmacists and GPs) were undertaken to determine the enablers & barriers to implementing a POCT-based COPD pathway within community pharmacies. Interviews were audio-recorded and transcribed verbatim for coding and inductive thematic analysis using a sequential inductive–deductive approach, with emergent themes organised using the Theoretical Domains Framework (TDF). Results 19 participants (11 pharmacists, 8 GPs) in London and Kent were interviewed. Thematic analysis identified themes included stakeholder factors, inter-professional relationship factors, organisational factors & POCT pathway factors. All participants supported the intervention, deeming it acceptable and feasible. Pharmacists were enthusiastic about expanding their clinical scope and felt confident that the intervention fitted their current role. GPs were willing to support the pharmacists. Proposed benefits of the intervention included more effective guided prescribing; the reassurance for patients and clinicians that would be obtained from objective results; the empowerment of patients and improvement in self-management of COPD; professional recognition of pharmacists’ clinical role; and an increased accuracy in the recording and monitoring of AECOPD treatment provision. Potential obstacles to implementing the intervention included data governance and communication challenges, concerns that patients might have preconceived ideas of their need for COPD standby rescue packs; the inconvenience for patients of visiting the pharmacy when they felt unwell; and patients’ potential reluctance to change their help-seeking behaviour. Conclusions Pharmacists and GPs supported the development and implementation of a POCT-based COPD pathway in community pharmacies, potentially improving patient medication stewardship.