Respiratory Infections HIT round up for 2016-17

An update on the work of the Respiratory Infections Health Integration Team during 2016-17 from Professor Alastair Hay.

Respiratory tract infections place considerable pressure on health care services. Children play a major role in spreading these infections. However, parents often don’t have the information to know when and how best to access health services for common illnesses. A vicious cycle is created of increasing patient demand, higher antibiotic use and a reduction in antibiotic effectiveness.

Locally, Bristol GPs have reduced their antibiotic prescriptions by 9 per cent in a year. Nationally, there is still a pressing need to improve stewardship of these drugs, 80 per cent of which are prescribed outside hospital.

The Respiratory Infections HIT (RuBICoN) has been working to improve advice and support for parents and patients, and to reduce antibiotic use in the treatment of respiratory infections, since December 2012.

We began the year by looking again at our work streams, and agreeing that the projects we’d focus on would be:

• Developing parent advice sessions on common childhood illnesses
• Providing GPs with personalised feedback on their antibiotic prescribing
• Point of care testing for lower respiratory tract infections

Between October 2016 and March 2017, we ran a feasibility pilot for introducing parent advice sessions on common childhood illnesses. These sessions, delivered by two healthcare professionals, a former GP and Health Visitor, give advice on ailments such as fever, viruses, bacterial infections, cough and breathing problems. They also signpost parents to where to find support, and how to care for children at home.

Ninety-nine parents attended six sessions at children’s centres in Bristol, North Somerset and South Gloucestershire. Feedback was excellent, with 99 per cent of parents rating the sessions ‘useful’ or ‘very useful’. Eighty-five per cent of attendees said they would do something different as a result of the session. The pilot demonstrated that this is a feasible delivery model that is well received by parents. We’re now working with Bristol Clinical Commissioning Group (CCG) to explore whether a larger project might be possible, aiming to reach 2,000 parents of children under the age of one.

We secured Research Capability Funding of £7,837 for a feasibility study to evaluate our intervention that gives personalised antimicrobial prescribing feedback to GPs. The intervention aims to improve antimicrobial stewardship.

The project will give regular updates to GPs in Bristol about their individual rates of antimicrobial prescribing benchmarked against others. This data, which isn’t easy to access at the moment, will be accompanied by national toolkits and resources, along with those produced by our TARGET research programme. We are collaborating with Bristol CCG’s medicines management team on this study.

Our patient member of the HIT executive has produced a patient’s view of antibiotics and self-care for respiratory tract infections. This is the first of many case studies which will help communicate different perspectives on the use of antibiotics.

An evaluation of the bronchiectasis HOT clinic at North Bristol NHS Trust provided encouraging data on patients’ quality of life and use of healthcare. There were trends towards lower levels of admissions, emergency department attendances and bed days in the trial year. We’ve now closed this work stream, after generating useful findings for future service development.

Point of care testing has been discussed regularly in the team. Collaborating with Public Health England we have shared intelligence on current use of testing in primary care. We have connected a researcher with an interest in this area with our colleagues in Public Health England. We have shared an audit of use of point of care testing, conducted by a member of our HIT, with colleagues.

The group has achieved much in the five years since it started out. We have had great success in funding major research projects, such as TARGET, and developing service changes that are becoming embedded in business as usual. As our work streams are now moving forward with other collaborators, the time has come to close RuBICoN as a Health Integration Team. The group will continue to exist as a forum for sharing progress and ideas, but this will be the last report for the Bristol Health Partners annual review.