BACKGROUND: Differentiating between bacterial and viral lower respiratory tract infections (LRTIs) presents a challenge for clinicians. This impacts patient management and treatment decisions, meaning patients with suspected viral infections often receive unnecessary antibiotics. The objective of this care pathway analysis (CPA) was to establish the potential positioning of a new test (MeMed BV) in the LRTI pathway in UK Emergency Departments (EDs).
MATERIALS: Semi-structured interviews of clinicians with experience in the diagnosis and management of LRTIs and budget holders were undertaken via Zoom. Thematic analysis and qualitative synthesis were conducted.
RESULTS: Ten clinicians, three budget holders, and one diagnostic adoption specialist were interviewed between July and August 2023. Based on the clinicians’ feedback, we developed a flow-diagram of the main decision points in the current diagnostic pathway for LRTIs and a separate diagram including the new test. From the interviews, the main variations between hospitals were the timing of blood draw and availability of diagnostic point-of-care tests (POCTs). Clinicians made recommendations about the unmet clinical needs (e.g. reducing people going to EDs for LRTI unnecessarily and identifying bacterial infections likely to deteriorate); new test positioning (at the beginning of the pathway to identify patients for further testing and antibiotic prescriptions); and potential barriers to adoption (e.g. cost of the test and pipetting constraints). They also discussed evidence requirements (e.g. need for UK outcome data and cost effectiveness compared with the current standard of care); further technical development with associated benefits (e.g. finger prick version of the test for children); and potential value propositions (e.g. reduction of ED waiting times and admissions while waiting for test results in the most severe population with uncertain diagnoses). Budget holders advised on the process for test adoption: clinical and laboratory staff are key decision makers, with POCTs processed through clinicians and laboratory tests through the laboratory team. A business case is needed on a hospital-by-hospital basis.
CONCLUSIONS: The analysis provides useful information to inform evidence generation and test implementation. Since CPA is an iterative process, value propositions and test positioning need further refinement and validation through clinical studies, economic assessments, and clinical opinion elicitation.