Understanding the management of common infections in out-of-hours primary care

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

M.1

Presenter:

Rebecca K Barnes

Twitter:

@DrRebeccaBarnes

Co-authors:

Geraldine Leydon-Hudson, Matthew Booker, Paula Gomes Alves, Gail Hayward, Jennie Hayes, Lydia Holt, Paul Little, Michael Moore, Fiona Stevenson, Beth Stuart, Catherine Woods

Author institutions:

University of Bristol, University of Southampton, University College London, University of Oxford

Problem

Despite a reduction in antibiotic consumption in general practice settings over the last five years, there is evidence that antibiotic prescribing rates in out-of-hours primary care have remained stable. Prior research has shown that communication plays a significant role in antibiotic prescribing decisions in-hours; and that training promoting clear communication about infection symptoms and treatment has shown some success. Our aim is a) to explore the management of common infections out-of-hours to understand factors influencing prescribing; and b) to develop evidence-based communication training to optimise prescribing decisions tailored to the common challenges faced in this setting.

Approach

A mixed methods approach was chosen consisting of three sequential phases: i) a realist-informed scoping review of current provider training and clinical guidelines for antibiotic prescribing in primary care; ii) three concurrent studies - one qualitative, making use of recorded encounters with eligible patients/carers and conversation analytic methods to explore the social context of individual prescribing decisions; two quantitative, involving the statistical analysis of survey data from participating clinicians and patients, and routine anonymised case records data from providers, to analyse the wider prescribing context; and iii) a mixed methods component bringing together the findings from phases one and two, with input from clinicians, patients and carers.

Findings

Our phase one review found existing evidence highlighting specific challenges faced by primary healthcare professionals in managing patient expectations out-of-hours. Some studies reported that antibiotics may sometimes be prescribed to avoid having to negotiate an alternative. A wide range of guidelines and training materials on antibiotic prescribing were found to be available. However, none included guidance specific to the out-of-hours context. Phase two (March 2019 – March 2020) involves two large out-of-hours providers serving populations in the South and West of England. Our qualitative dataset will include up to 300 recordings of advice calls, base and home visits including GPs, nurses and paramedics. Eligible patients include community dwelling children and adults as well as care home residents. Over 50% of our participants are over 70 years old. The two main types of infections being managed currently are respiratory and urological. 60% of home visits end in an antibiotic prescription compared to 48% of base visits.

Consequences

Our interim findings show high levels of antibiotic prescribing in comparison to in-hours primary care. Our work will enable new insights into understanding antibiotic prescribing patterns out-of-hours. This will be the basis for a new e-Learning for Healthcare (eLfH) programme hosted by Health Education England, drawing on real examples to guide the management of common infections out-of-hours. The eLfH platform has over one million registered users so the potential to influence future outcomes is significant.

Submitted by:

Rebecca Barnes

Funding acknowledgement:

This study/project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (project reference 414). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.