# Systematic method for developing tailored strategies for implementing point-of-care procalcitonin testing to guide antibiotic prescribing in Swiss primary care: a protocol for a mixed-methods participatory approach

## TL;DR

This study outlines a method to develop strategies for using a quick test to guide antibiotic use in Swiss primary care, aiming to reduce unnecessary prescriptions.

## Contribution

A systematic, participatory approach to tailor implementation strategies for point-of-care procalcitonin testing in primary care.

## Key findings

- The study uses a four-phase mixed-methods approach to identify and prioritize implementation barriers and facilitators.
- Expert and stakeholder input will guide the selection and refinement of implementation strategies based on APEASE criteria.
- Results will be shared through scientific publications and conferences to support antimicrobial stewardship.

## Abstract

Antimicrobial resistance is a major global health threat, driven largely by the misuse and overuse of antibiotics. Point-of-care (POC) tests for inflammatory biomarkers like procalcitonin (PCT) have shown promise in reducing unnecessary antibiotic prescriptions. The hybrid type II ImpPro trial aims to evaluate the implementation and effectiveness of POC-PCT on antibiotic prescriptions by primary care physicians (PCP) in French-speaking Switzerland. Implementation is planned to include a multifaceted strategy delivered mainly, but not exclusively, via PCP quality circles. Currently, little guidance exists on how to best tailor the implementation strategies to a specific context. This study protocol describes the comprehensive approach taken within ImpPro to develop a multifaceted and multilevel strategy for POC-PCT implementation.

Our mixed-methods participatory implementation research study consists of four phases: (1) determinant identification; (2) determinant prioritisation; (3) implementation strategy ideation and (4) implementation strategy selection and refinement. All phases of the study will be guided by well-established implementation theories, models and frameworks. For 1, to identify the possible barriers and facilitators for implementation, we will conduct semistructured interviews with stakeholders followed by deductive coding using the updated Consolidated Framework for Implementation Research and inductive thematic analysis. In 2, to identify the key determinants, we will conduct online focus group discussions and vote on the importance and changeability of determinants. In 3, we will conduct interviews and an expert brainstorming session, followed by deductively coding implementation ideas according to the Expert Recommendations for Implementing Change compilation. In 4, we will conduct focus group discussions with experts and stakeholders about the APEASE criteria (ie, affordability, practicability, (cost-)effectiveness, acceptability, side effects and safety and equity) of these strategies, followed by a rapid data analysis approach to select the implementation strategies.

This study does not fall within the scope of the Human Research Act, and the necessity for a formal evaluation was waived from the Cantonal Ethics Committee (Req-2023–00392). The results of our study will be shared among the Antimicrobial Stewardship in Ambulatory Care Platform network, published in peer-reviewed scientific journals, and will be presented at international and national conferences.