Respiratory Infections Health Integration Team review of 2013-14

Professor Alastair Hay reflects on the achievements of the Respiratory Infections Health Integration Team (HIT) during 2013-14.

Every winter health
care services are overwhelmed by patients with respiratory tract infections
(RTIs). Children play a key role in respiratory infection transmission, with
enormous cost implications for societies and healthcare systems worldwide.
Prescribing rates for antibiotics in primary care settings are high, with
considerable uncertainty regarding which patients are most likely to benefit.
Higher use of antibiotics in primary care is associated with greater levels of
bacterial resistance. This creates a vicious cycle of increasing patient
demand, increasing antibiotic use and reducing antibiotic effectiveness. The
Respiratory Infections HIT (RuBICoN) aims to reduce the burden of respiratory
infections on both the NHS and the community.

We now have an active Patient & Public Involvement (PPI)
group that informs our grant applications and provides guidance on the patient
information we are producing. We are working with commissioners and health
educators so that Bristol-based research evidence informs interventions and
helps parents make better decisions about when and where to consult the NHS if
their children become ill.

We have led changes to the bronchiectasis HOT clinic at
North Bristol Trust, allowing patients to make direct contact with the clinic
when they are unwell. This gives more rapid access to specialist care, which we
hope will result in faster, more appropriate care and reduce hospital
admissions.

The team
has submitted a grant application to the National Institute of Health Research
(NIHR) to evaluate the clinical and cost effectiveness of analgesic ear drops
as an alternative to antibiotics in acute otitis media, a common respiratory
infection of children that can case ear pain. We’ve also prepared an outline
NIHR Programme Grant for Applied Research application to conduct a community
based prospective cohort study to investigate the socio-demographic, clinical
and microbiological determinants of primary care utilisation for children with
RTIs and to develop an intervention to improve parental use of primary care.

We have mapped the educational provision around infection
prevention and control within the NHS locally. The next steps are to identify
gaps and provide educational sessions to raise the profile of these issues in the
partner organisations. And finally, we have expanded our links with industry
partners and are looking, with them, to develop or evaluate near patient
microbiological testing. This will facilitate rapid diagnostics in those
individuals in which a swift diagnosis can assist in deciding the treatment
options.