Education to improve timeliness of shingles diagnosis in primary care: a cluster randomised study within a trial with nested qualitative study
Education to improve timeliness of shingles diagnosis in primary care: a cluster randomised study within a trial with nested qualitative study
Background Herpes zoster (shingles) is normally diagnosed clinically. Timely diagnosis is important so that antiviral treatment can be started soon after rash onset. Aim To assess whether a practice-level educational intervention, aimed at non-clinical patient-facing staff, improves the timely assessment of patients with shingles. Design and setting This was a cluster randomised study within a trial (SWAT) with nested qualitative study in general practices in England. Method Practices were cluster randomised 1:1, stratified by centre and minimised by practice list size and Index of Multiple Deprivation score. Intervention practices were sent educational materials, highlighting the common presenting features of shingles and what action to take if suspected. The primary and secondary outcomes were the mean proportion of patients per practice seen within 72 and 144 h of rash onset, respectively. Comparison between groups was conducted using linear regression, adjusting for randomisation variables. Semi-structured interviews with practice staff in intervention practices explored views and opinions about the intervention. Results In total, 67 practices were enrolled; 34 randomised to the intervention and 33 to the control. The mean difference in proportion of patients seen within 72 and 144 h was –0.132 (95% confidence interval [CI] = –0.308 to 0.043) and –0.039 (95% CI = –0.158 to 0.080), respectively. In intervention practices, 90.9% reported distributing the educational materials; however, engagement with these was suboptimal. Twelve participants were interviewed, and the poster component of the intervention was said to be easiest to implement. Conclusion Our educational intervention did not improve the timely assessment of patients with shingles. This may be the result of poor intervention engagement.
diagnosis, general practice, herpes zoster, interprofessional education
Lovegrove, Elizabeth
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MacNeill, Stephanie J.
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Liu, Yumeng
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Rees, Sophie
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Banks, Jonathan
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Johnson, Robert
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Ridd, Matthew J.
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September 2024
Lovegrove, Elizabeth
d7b61630-099a-4faf-94a8-10506cc9887c
MacNeill, Stephanie J.
2c5c4027-4f93-4cc8-a56c-fa85772f3a09
Liu, Yumeng
48354556-dc89-4a18-9727-0918f649e355
Rees, Sophie
28985cfe-eef6-4687-a7e5-c352b5a61fb1
Banks, Jonathan
b4ef622f-0266-44c5-983f-5461bd24807c
Johnson, Robert
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Ridd, Matthew J.
0b77589c-5c28-4767-bfaf-ecbe0e42f1ff
Lovegrove, Elizabeth, MacNeill, Stephanie J., Liu, Yumeng, Rees, Sophie, Banks, Jonathan, Johnson, Robert and Ridd, Matthew J.
(2024)
Education to improve timeliness of shingles diagnosis in primary care: a cluster randomised study within a trial with nested qualitative study.
The British journal of general practice : the journal of the Royal College of General Practitioners, 74 (746), [BJGP.2023.0477].
(doi:10.3399/BJGP.2023.0477).
Abstract
Background Herpes zoster (shingles) is normally diagnosed clinically. Timely diagnosis is important so that antiviral treatment can be started soon after rash onset. Aim To assess whether a practice-level educational intervention, aimed at non-clinical patient-facing staff, improves the timely assessment of patients with shingles. Design and setting This was a cluster randomised study within a trial (SWAT) with nested qualitative study in general practices in England. Method Practices were cluster randomised 1:1, stratified by centre and minimised by practice list size and Index of Multiple Deprivation score. Intervention practices were sent educational materials, highlighting the common presenting features of shingles and what action to take if suspected. The primary and secondary outcomes were the mean proportion of patients per practice seen within 72 and 144 h of rash onset, respectively. Comparison between groups was conducted using linear regression, adjusting for randomisation variables. Semi-structured interviews with practice staff in intervention practices explored views and opinions about the intervention. Results In total, 67 practices were enrolled; 34 randomised to the intervention and 33 to the control. The mean difference in proportion of patients seen within 72 and 144 h was –0.132 (95% confidence interval [CI] = –0.308 to 0.043) and –0.039 (95% CI = –0.158 to 0.080), respectively. In intervention practices, 90.9% reported distributing the educational materials; however, engagement with these was suboptimal. Twelve participants were interviewed, and the poster component of the intervention was said to be easiest to implement. Conclusion Our educational intervention did not improve the timely assessment of patients with shingles. This may be the result of poor intervention engagement.
Text
BJGP.2023.0477.full
- Accepted Manuscript
More information
Accepted/In Press date: 4 March 2024
e-pub ahead of print date: 18 March 2024
Published date: September 2024
Additional Information:
Copyright © 2024, The Authors.
Keywords:
diagnosis, general practice, herpes zoster, interprofessional education
Identifiers
Local EPrints ID: 488378
URI: http://eprints.soton.ac.uk/id/eprint/488378
ISSN: 0960-1643
PURE UUID: b924b250-9ed4-4e65-9d62-5a5302392ecc
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Date deposited: 21 Mar 2024 17:34
Last modified: 31 Oct 2024 17:44
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Contributors
Author:
Stephanie J. MacNeill
Author:
Yumeng Liu
Author:
Sophie Rees
Author:
Jonathan Banks
Author:
Robert Johnson
Author:
Matthew J. Ridd
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