Haenssgen, Marco Johannes, Charoenboon, Nutcha, Althaus, Thomas, Greer, Rachel C., Intralawan, Daranee and Lubell, Yoel (2018) The social role of C-reactive protein point-of-care testing to guide antibiotic prescription in Northern Thailand. Social Science & Medicine, 202 . pp. 1-12. doi:10.1016/j.socscimed.2018.02.018

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Abstract

New and affordable point-of-care testing (POCT) solutions are hoped to guide antibiotic prescription and to help limit antimicrobial resistance (AMR)—especially in low- and middle-income countries where resource constraints often prevent extensive diagnostic testing. Anthropological and sociological research has illuminated the role and impact of rapid point-of-care malaria testing. This paper expands our knowledge about the social implications of non-malarial POCT, using the case study of a C-reactive-protein point-of-care testing (CRP POCT) clinical trial with febrile patients at primary-care-level health centres in Chiang Rai province, northern Thailand. We investigate the social role of CRP POCT through its interactions with (a) the healthcare workers who use it, (b) the patients whose routine care is affected by the test, and (c) the existing patient-health system linkages that might resonate or interfere with CRP POCT. We conduct a thematic analysis of data from 58 purposively sampled pre- and post-intervention patients and healthcare workers in August 2016 and May 2017.
We find widespread positive attitudes towards the test among patients and healthcare workers. Patients’ views are influenced by an understanding of CRP POCT as a comprehensive blood test that provides specific diagnosis and that corresponds to notions of good care. Healthcare workers use the test to support their negotiations with patients but also to legitimise ethical decisions in an increasingly restrictive antibiotic policy environment. We hypothesise that CRP POCT could entail greater patient adherence to recommended antibiotic treatment, but it could also encourage riskier health behaviour and entail potentially adverse equity implications for patients across generations and socioeconomic strata. Our empirical findings inform the clinical literature on increasingly propagated point-of-care biomarker tests to guide antibiotic prescriptions, and we contribute to the anthropological and sociological literature through a novel conceptualisation of the patient-health system interface as an activity space into which biomarker testing is introduced.

Item Type:	Journal Article
Subjects:	H Social Sciences > H Social Sciences (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Arts > School for Cross-faculty Studies > Global Sustainable Development
Library of Congress Subject Headings (LCSH):	Point-of-care testing -- Thailand, Drug resistance in microorganisms -- Developing countries, Antibiotics, Drugs -- Prescribing, C-reactive protein -- Health aspects, Patient compliance
Journal or Publication Title:	Social Science & Medicine
Publisher:	Elsevier
ISSN:	0277-9536
Official Date:	April 2018
Dates:	Date Event April 2018 Published 23 February 2018 Available 20 February 2018 Accepted
Date of first compliant deposit:	15 November 2018
Volume:	202
Page Range:	pp. 1-12
DOI:	10.1016/j.socscimed.2018.02.018
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED Foundation for Innovative New Diagnostics http://viaf.org/viaf/123746350 105605/Z/14/Z Wellcome Trust http://dx.doi.org/10.13039/100010269 105032/Z/14/Z Wellcome Trust http://dx.doi.org/10.13039/100010269

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