Focus on the Respiratory Infections HIT

It’s the time of year when we’re all plagued by coughs and colds. The Respiratory Infections Health Integration Team, also known as RuBICoN HIT, is working hard to reduce the burden of these illnesses on both the NHS and the population of Bristol. RuBICoN stands for Reducing the Burden of Infections in the Community and the NHS.

RuBICoN is a team of doctors and scientists, working together to improve advice and support for parents and patients, and to reduce antibiotic use in the treatment of respiratory infections.

They are working to improve how coughs, colds and chest infections are managed to try to help people to look after themselves, help the NHS treat those who are more seriously ill every winter and improve the way money is spent. They plan to achieve this by providing new clinics, and by giving better information and skills to parents, supported by good science to help them manage these infections with confidence.

Infectious diseases are most common and serious in the very young or old. The economic burden from infectious diseases in England, including costs to the health service, to the labour market and to individuals themselves, is estimated at £30 billion each year. A large proportion of these costs are from respiratory infections.

What they’ve achieved so far

Recent highlights for the team include working with parents, patients and the public to inform the group’s priorities and projects. They are also working with the local clinical commissioning groups to ensure scientific evidence is used in leaflets and other materials given to parents in clinics.

The team is also setting up clinics for new parents. Designed to help parents understand how to keep children well and when to take action if a child is ill, they will signpost people to the most appropriate source of help for them at the time.

They are also making changes to an existing clinic for out-patients at North Bristol Trust with a disease called bronchiectais. This will allow patients to make direct contact with the clinic when the disease is active, rather than going to their GP first. The changes to the clinic will uncover whether new technology can be used to assess the infection, allowing a more appropriate use of antibiotics. They hope that a further benefit will be reduced hospital admissions for these individuals.

The team has been part of a systematic review looking at the duration of respiratory tract infections in children, published in the BMJ on 11 December 2013. The review found that the time for 90 per cent of children to recover from otitis media is seven to eight days, whereas NICE suggests it should be four days, and acute cough is actually 25 days not 21 days.

Upcoming projects and activities

The team has secured funding for a literature review around infection transmission and prevention, to produce documentation for and run the new parent clinic, and get feedback from patients, parents and the public on the clinic materials.

They will also review the education of health care professionals on infection prevention and control. Education is often delivered separately and inconsistently across health care providers, which can lead to gaps or duplication in services and advice. The HIT wants all health care professionals to have a common understanding, to provide the same advice to patients wherever they present for help.

The team is talking to industry about developing new ‘point-of-care’ testing. This will enable Bristol to be an early adopter of the technology which, it is hoped, will detect whether an infection is caused by a bacterium or a virus. The different causes need different treatments, if indeed treatment is required, and antibiotics are often prescribed because of a lack of certainty in diagnosis.

The team has been shortlisted to develop a trial looking at using a painkilling ear drop in primary care rather than antibiotics, for which there is no proven benefit, for the ear infection otitis media. The team will find out if their application was successful in June, with funding beginning in 2015.

And the team will continue to evaluate all the changes they make to ensure that they benefit patients and improve health care.

HIT Director Alastair Hay says: “Working together, this team has great potential to transform the understanding of what is normal in respiratory tract infections, what parents want to know about self-management and what can be done to improve the health care and management of them.”