Large-scale European VALUE-Dx project shows point-of-care testing is a behavioral intervention, not a quick technological fix

Antwerp/Oxford/Utrecht – Making rapid diagnostic tests (point-of-care or POC tests) available in general practice does not, by itself, lead to fewer antibiotic prescriptions for patients with respiratory infections. This is the key conclusion of the international clinical PRUDENCE trail and its process evaluation conducted by the Universities of Antwerp, Oxford, and Utrecht as part of the European VALUE-Dx project. The study findings have now been published in the medical journal The Lancet Primary Care.

The PRUDENCE Trial

The PRUDENCE trial compared standard care with and without a POC testing strategy across thirteen countries. The strategy included blood tests for inflammatory markers (CRP), throat swabs for Group A Streptococcus, and nasal swabs for influenza in patients for whom the doctor was considering antibiotics. The results showed that the availability of these tests did not lead to a reduction in prescriptions. Furthermore, the time to recovery was identical in both groups: four days.

"POC tests are not a simple technological quick fix. They can serve as a lever for better prescribing behaviour, but only when the right conditions are met," says Prof. Sibyl Anthierens (University of Antwerp).

Why don’t tests work automatically?

The process evaluation demonstrates that doctors systematically ignore test results in three specific situations: when symptoms are perceived as "classically bacterial", when the test result conflicts with their clinical intuition, and when a prescription has already been promised to the patient before the test result is available. Importantly, testing works bidirectionally: an unexpected positive test result sometimes led to a prescription that the doctor had not initially planned. The goal of testing is not necessarily to always prescribe less, but to prescribe more accurately and safely.

The role of the patient

Patients also play a significant, often underestimated role. They are more likely to accept test results when they align with their own expectations, but often question them when they perceive their symptoms as severe. However, patients who understood what the test measured and what a negative result signified were more willing to adjust their expectations regarding antibiotics. Many of these patients spontaneously cited antibiotic resistance as a motivation for avoiding unnecessary medication.

A new agenda for healthcare

The study highlights that POC tests must be embedded within a broader package of interventions. This concrete agenda includes:

-          Communication training for physicians

-          Delayed decision-making, where the prescription decision is postponed until after the test results are in

-          Enhanced support for test interpretation

-          Targeted patients education to help them understand what the test measures and what the results mean.

The question is no longer whether POC tests work, but under what conditions they can function optimally—and how policy and medical education can actively create those conditions.

About the study

VALUE-Dx: A European consortium funded by the EU (Innovative Health Initiative) and coordinated by Prof. Herman Goossens (University of Antwerp).

PRUDENCE Trial: Led by Prof. Chris Butler (University of Oxford) and Prof. Alike van der Velden (University of Utrecht).

Process Evaluation: Led by Prof. Sibyl Anthierens (University of Antwerp) and Prof. Sarah Tonkin-Crine (University of Oxford).

Belgian General Practice Network: Led by Prof. Samuel Coenen (University of Antwerp).

Scope: Conducted across thirteen European countries, with the process evaluation taking place in six: Belgium, Germany, England, Georgia, Greece, and Ireland.

Publications:

Alike W van der Velden, Samuel Coenen, Emma Harper, Marilena Anastasaki, Sibyl Anthierens, Femke Böhmer, Emily Bongard, Julie Domen, Ana Garcia-Gangenis, Gail N Hayward, Bernadett Kovacs, Anna Kowalczyk, Carl Llor, Lile Malania, Fulvia Mazzaferri, Sam Mort, Joanna Moschandreas, Louise Rossignol, Benjamin R Saville, Milensu Shanyinde, Evelina Tacconelli, Sarah Tonkin-Crine, Philip J Turner, Akke Vellinga, Marta Wanat, Ly-Mee Yu, Adam Zerda, Susanne Emmerich, Herman Goossens, Christopher C Butler Point-of-care testing strategy versus usual care to safely reduce antibiotic prescribing for acute respiratory tract infections in primary care (PRUDENCE): a pragmatic, randomised controlled trial in 13 countries March 2026, The Lancet Primary Care, https://doi.org/10.1016/j.lanprc.2025.100104

Marta Wanat, Melanie E. Hoste, Marilena Anastasaki, Femke Böhmer, Annelies Colliers, Maria Gkamaletsou, Prof Herman Goossens, Christin Löffler, Prof Christos Lionis, Lile Malania, Mala Shah, Anja Wollny, Prof Akke Vellinga, Prof Christopher C. Butler, Alike W. van der Velden, Prof Sibyl Anthierens, Prof Sarah Tonkin-Crine Clinician and patient experiences with point-of-care testing for acute respiratory infections in primary care: a qualitative process evaluation of the PRUDENCE trial March 2026, The Lancet Primary Care, https://doi.org/10.1016/j.lanprc.2025.100105

The Lancet Primary Care Comment: https://doi.org/10.1016/j.lanprc.2026.100121

Note: The study team leads wish to express their sincere gratitude to all collaborators — including the authors, laboratory staff, clinical networks, physicians, and patients across all participating countries — for the tremendous efforts they have made in contributing to these studies.