Research project

PHASED IN - PHarmacy partnership using decision-making tools and near patient testing for Antimicrobial Stewardship for EveryDay practice IN primary care

Project overview

Background
One in three people see doctors, nurses, or pharmacists each year with common infections, such as colds, flu, chest, ear, sinus and urine infections. Currently most antibiotics are prescribed in general practices, and half of the people contacting general practices with infections receive antibiotics, but antibiotics mostly don’t help. Overuse of antibiotics harms people and causes antibiotic resistance to develop, where antibiotics no longer work well.

This could make modern medicine, such as routine surgery and cancer treatments, difficult or impossible. Early evidence from community pharmacy ‘minor illness’ schemes, and from piloting of redirection of patients presenting with infections to linked community pharmacies, suggests this is probably both safe and may lower antibiotic use. However, these services are not widely available. Although a new national pharmacy infection management scheme is being negotiated it is going to be limited in scope. There is no high-quality scientific evidence for this type of infection service.

Aim
To finish development and feasibility test a pharmacy package using decision-making tools and POCTs to share the management of acute infections in primary care.

Developing tools to support antibiotic stewardship
We are developing evidence based ‘decision-making tools’ to standardise care and help identify people who do not need antibiotics, and those who might need them, or need further assessment. The intervention will include these decision-making tools, as well as diagnostic tests that can be carried out on the spot if needed (such as C-reactive protein) and patient leaflets to support self-care. There will be a training package to help health professionals to use all these tools in patient consultations. We will continue working closely with patients, pharmacists, and other prescribers from general practice (GPs, nurses) to make sure the tools and training are helpful and easy to use.

Testing the feasibility of using the package
10 general practices will continue with management as usual, and 10 will be trained to refer patients presenting with common infections to linked community pharmacies who will use the intervention. We will include practices in a wide range of settings (including high and low income areas, urban and rural, and practices with high ethnic minority populations) and will look at how well the service works, what the implications are for providing the service, and patient and healthcare professional views with a view to any revisions needed prior to a fuller trial of the new service.

PPIE
Public contributors have helped design this study, are members of our study team, and will be involved in study management, delivery, and dissemination. We have also recruited a PPIE reference group with a wider range of people from different backgrounds to help throughout the study.

Staff

Lead researchers

Professor Paul Little

Professor in Primary Care Research
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Other researchers

Dr Mark Lown

Associate Professor
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Professor Gareth Griffiths

Director SCTU & Prof of Clinical Trials

Research interests

  • Gareth Griffiths is Professor of Clinical Trials and directs our Southampton Clinical Trials Unit.  He works with clinicians, research groups and other scientists in the development of important clinical trials and other well-designed studies that aim to improve the treatment of a range of cancers and other diseases, and early diagnosis of cancer.
  • His works spans the different phases of clinical trials, from small dose finding and safety studies involving a handful of patients to larger trials of hundreds of patients looking at whether the treatments are better than the current standard treatments.  His early diagnosis studies include thousands of patients looking at new ways to detect cancer early.  Ultimately, these studies could help change the way that patients are treated for the better, by creating the evidence so as the new treatments becomes the standard of care for future patients treated in the NHS.
  • Phase I-III clinical trials
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Professor Ingrid Muller BSc, MSc, PhD, CPsychol, FHEA

Professor

Research interests

  • Self-management of long-term conditions
  • Behavioural health interventions
  • Digital health
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Professor Sue Latter

Professor of Health Services Research

Research interests

  • Medicines management
  • Prescribing
  • End-of-life medicines management
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Professor Nick Francis

Head of School

Research interests

  • Infections in primary care
  • Antimicrobial stewardship
  • Respiratory infections
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Professor Tracey Sach

Professor in Health Economics

Research interests

  • Health economics
  • Economic evaluation methodology and application, particularly alongside randomised controlled trials
  • Outcome measurement including non-monetary preference-based methods
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Professor Lucy Yardley OBE

Professorial Fellow-Research
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Dr Taeko Becque

Senior Clinical Trials Statistician

Research interests

  • Medical statistics
  • Randomised trials
  • Primary care
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Dr Jane Vennik

Senior Research Fellow
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Mrs Sam Williams

Trial Manager
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Dr Sascha Miller

Senior Research Fellow (Qualitative)

Research interests

  • Implementation of digital intervention Mixed methods process evaluations of digital interventions Antimicrobial resistance and infection prevention
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Collaborating research institutes, centres and groups

Research outputs