Diagnosis and management of infectious disease in primary care during the COVID-19 lockdown: changes in antibacterial and antiviral use

Date of ISAC Approval: 
15/05/2020
Lay Summary: 
Public health measures introduced to reduce the spread of COVID-19 has led to rapid changes in the way general practices deliver care, with greater use of telephone and video consultations, and a significant change in how and when patients access services. Infectious diseases, including respiratory and urinary tract infections, are the most common reasons why patients see a GP. We think the COVID-19 lockdown may have changed the way patients seek healthcare for infectious diseases, and how GPs treat these infections. Using anonymised primary care medical records, we would like to find out 1. Whether more or less a) infectious diseases are being diagnosed, and b) drugs used to treat infections are being prescribed, during the UK COVID-19 lockdown, and if changes are related to practice characteristics such as poverty, previous infection consultation behaviour 2. If certain patients with an infection are more or less likely to be treated with antibacterial/antivirals 3. Which medications are being prescribed to patients with COVID-19 4. Whether more or less patients registered to practices with fewer infectious disease diagnoses are going to hospital with an infectious disease. The information will help us understand whether patients are seeking help less for infectious diseases in general practice, and whether this leads to more hospital attendances, and if GPs are changing the way they prescribe medication for infectious disease. Understanding the impact of the COVID-19 lockdown on the general population’s health will inform the delivery of primary care during the potential second wave of COVID-19 expected in the Autumn.
Technical Summary: 
In response to the COVID-19 pandemic, the delivery of primary care has rapidly changed to meet sudden increases in demand and social distancing measures to reduce the potential spread of infection. Furthermore, patients are changing their health seeking behaviour, with reductions in health service utilisation. Infectious diseases are the most common presentations treated in primary care, with respiratory tract infections the most frequently prescribed antibiotics. Given these changes in health service use and delivery, it is unknown how the management of infectious disease in primary care will be impacted during the COVID-19 lockdown. Opportunities for early intervention may be being missed, potentially leading to serious complications and greater use of acute care services during a period when they are already overwhelmed. The objective of this study is to investigate changes in diagnosis and treatment of infectious diseases, and associated hospital admissions, during the COVID-19 UK lockdown. We will conduct a retrospective cohort analysis comparing practice-rates of infectious disease diagnoses and antibacterial and antiviral prescriptions pre and during the COVID-19 lockdown. We will investigate practice and patient-level factors associated with changes in the treatment of specific infectious diseases, including COVID-19. Furthermore, we will examine whether changes in practice-level hospital attendance for infectious diseases are associated with changes in diagnosis and prescribing in primary care. Mixed-effect regression models will be used to investigate associations with practice and patient-level factors. Little attention is currently being paid to general practice, and results from this study will provide an insight into the changes in diagnosis and treatment of the most common presentations in primary care during COVID-19 lockdown, and the potential impact on hospital attendance for non-COVID-19 infections. Findings will inform the delivery of primary care for the management of infectious disease during a potential COVID-19 second wave, expected in Autumn.
Health Outcomes to be Measured: 
Four main outcomes will be measured in this study. - Changes in practice-level rates of specific infectious disease diagnoses, per 1,000 patients pre and during COVID-19 lockdown - Changes in practice-level rates of antibacterial and antiviral prescribing, per 1,000 patients pre and during COVID-19 lockdown - Change in practice-level rates of hospital attendance with specific infectious disease diagnoses, per 1,000 patients - Antibacterial or antiviral prescription (yes/no)
Collaborators: 

Rachel Denholm - Chief Investigator - University of Bristol
Alastair Hay - Collaborator - University of Bristol
Jessie James - Collaborator - University of Bristol
Rachel Denholm - Corresponding Applicant - University of Bristol
Rupert Payne - Collaborator - University of Bristol

Linkages: 
2011 Rural-Urban (Non-standard) LSOA;HES A&E;Patient IMD