Does a practice-level educational intervention improve the timely assessment of adults with shingles? Cluster randomised trial with nested qualitative study.

Conference: 
SAPC ASM 2023 - Brighton
Talk Code: 
2C.7
Presenter: 
Elizabeth Lovegrove
Twitter: 
@E_Lovegrove
Co-authors: 
Dr Stephanie MacNeill, Ms Yumeng Liu, Dr Sophie Rees, Dr Jonathan Banks, Mr Seamus Gate, Dr Robert Johnson, Professor Matthew Ridd, on behalf of the ATHENA trial team
Author institutions: 
Primary Care Research Centre, University of Southampton, Centre for Academic Primary Care University of Bristol, Bristol Population Health Science Institute University of Bristol

Problem

Herpes zoster (shingles) is normally diagnosed in primary care on the basis of symptoms and it’s characteristic rash. Antiviral treatment is recommended if the patient is diagnosed within 3-7 days of rash onset. The majority of appointments with primary care clinicians are made via receptionists, who commonly ask about the reason for the appointment. Due to the unique nature of shingles presentation and the time-sensitive nature of treatment, we sought to explore whether the timeliness of shingles diagnosis can be improved by a practice wide educational intervention.

Approach

Aim: To assess whether a practice level educational intervention, aimed at non-clinical patient-facing staff, improves the timely assessment of patients with shingles. Methods: A cluster (GP surgery level) randomised study within a trial (SWAT), with nested qualitative study was undertaken, hosted by the AmiTriptyline for the prevention of post-Herpetic NeuralgiA (ATHENA) trial (NIHR HTA reference 129720). Participating SWAT surgeries were randomised (1:1), stratified by centre and minimised by practice list size and index of multiple deprivation score. Intervention surgeries were sent an educational poster, desktop background and one-minute animation video highlighting the common symptoms and signs of shingles, the importance of early recognition and action to take. The primary and secondary outcomes were the mean proportion of patients seen within 72 hours and 144 of rash onset, respectively. Comparison between groups was conducted using linear regression, adjusting for randomisation variables. This SWAT was registered with the Northern Ireland Hub for Trials Methodology Research SWAT repository, reference 173.

Findings

The mean difference in proportion of patients seen within 72 and 144 hours was -0.132 (95% CI -0.308, 0.043) and -0.039 (95% CI -0.158, 0.080) respectively. 12 participants were interviewed, and the poster component of the intervention was reported to be easiest to implement. There were some difficulties reported in employing the desktop background and this was less frequently used. 76.5% of intervention practices viewed the educational video.

Consequences

Our educational intervention did not improve the timely assessment of patients with shingles. Further analyses regarding the implementation of the intervention are underway and will be presented. In particular, the challenges of running this SWAT within the host ATHENA trial will be highlighted. Furthermore, learning for future interventions designed to improve timely diagnosis of acute conditions, and or also improve recruitment into clinical trials of treatments for these conditions, will be presented.

Submitted by: 
Elizabeth Lovegrove
Funding acknowledgement: 
The ATHENA clinical trial is being funded by the “research arm” of the NHS, the National Institute for Health Research Health Technology Assessment programme (NIHR HTA reference 129720).