Avon Community Acquired Pneumonia General Practice Study, Part 1 (AvonCAP GP1)
Establishing the burden of vaccine preventable lower respiratory tract infections in general practices in the UK – Part 1: improving the use of diagnostic codes for acute respiratory tract infections
Lead researchers
Principal Investigator: Dr Polly Duncan
Chief Investigator: Prof. Adam Finn
Senior Investigator: Prof. Alastair Hay
About the study
The 'AvonCAP General Practice Part 1' study is part of the COVID-19 AvonCAP Study. It is the first in a series of studies that aim to understand the number of patients presenting to general practice with chest infections and pneumonia and, of these, what proportion could be prevented by vaccinations.
It will provide information on:
- the types of patients more likely to become severely unwell
- healthcare use amongst these patients (e.g. use of antibiotics, hospital admissions), and
- common viruses and bacteria that cause these infections, which will help in improve patient management.
This research will help us estimate the likely benefit of vaccinations to the UK population as a whole and to specific high-risk groups of patients (i.e. those most at risk of severe illness).
Previous research has estimated how common chest infections are in UK general practice, but it is likely that infections are under-reported.
One study looked at routinely collected information from the electronic GP records of almost 900 GP practices in the UK. The problem with this type of study is that only information that has been coded correctly is picked up, and we know that infections are often not coded well by primary care health professionals. For example, a GP might suspect a patient has a chest infection and prescribe an antibiotic but record the illness using a symptom code, such as ‘cough’, rather than a diagnostic code, such as ‘lower respiratory tract infection’.
Another study highlighted this issue, reporting that 37% of antibiotics prescribed were not linked to a diagnostic code.
Another reason to encourage health professionals to use standardised diagnostic codes for respiratory infections is that antibiotic prescribing can then be compared between different types of clinicians and primary care providers. Ultimately, this offers the prospect of being able to provide individualised, peer-referenced antibiotic prescribing data, which could help clinicians reflect on, and improve, their prescribing of antibiotics. This is important to prevent antibiotic resistance, where infections no longer respond to antibiotics because they have been prescribed too readily.
We are also interested in patients with heart failure, as worsening of heart failure can sometimes be triggered by viruses and other infections.
There is no patient participation in the AvonCAP GP1 study but we will be recruiting patients who are diagnosed with a respiratory tract infection (RTI) for the main part of the study, starting in Autumn 2021.
Project aim
The primary aim of AvonCAP GP study 1 is to improve the use of diagnostic codes for children and adults presenting with acute respiratory tract infections or exacerbation of heart failure. A secondary aim is to describe the use of antibiotics for children and adults with acute respiratory tract infections, including delayed prescribing, where the patient is advised to hold off collecting and taking antibiotics as they may not be needed.
Anticipated impact
By improving the coding of respiratory infections in GP practices, we will be better placed to estimate the number of people with infections, thus helping to understand the true burden of these illnesses on the NHS.
We will also provide healthcare professionals with feedback about prescribing of antibiotics for common infections compared to their colleagues. This information will enable health professionals to reflect on their prescribing behaviour, and may reduce unnecessary use of antibiotics.
Project resources
Funder
The study is sponsored by the University of Bristol and is funded by Pfizer.
Project dates
Part 1 of the study will run from April to October 2021.
Contact
Dr Polly Duncan,
GP and Senior Research Fellow,
Centre for Academic Primary Care (CAPC),
Bristol Medical School,
University of Bristol,
Canynge Hall,
Whatley Road,
Bristol
BS8 2PS
avoncapgp-study@bristol.ac.uk
