MAIN HEADLINE:
Despite all efforts, non-clinical practice staff does not seem to benefit from educational interventions aimed at improving the timeliness of shingles diagnosis (i.e., within 72-144 hours).
METHODOLOGY:
- Researchers conducted a cluster randomized study within a study (SWAT) with a nested qualitative study of English general practitioners to determine whether a practice-based intervention to improve non-clinical staff knowledge would enhance timely diagnosis of new onset shingles.
- The primary endpoint was the proportion of patients seen within 72 hours of rash onset.
- Educational interventions included five posters displayed in staff areas, desktop backgrounds that could be uploaded to all staff-facing computers (reception, administrative and clinical staff), and a link to a one-minute YouTube video.
- Implementation was assessed by requesting an email confirmation of material receipt, an online survey on the number of posters, desktop backgrounds displayed in week 2 and last month, as well as YouTube analytics.
- An implementation rating on a scale from 0-3 was calculated for each practice, with 1 point awarded for engaging with each intervention material.
RESULTS:
- Of the 67 included practices, 34 were randomized to the SWAT group and 33 to the control group.
- For the primary endpoint, evidence for a distinction between SWAT and control groups in terms of average proportion of patients seen within 72 hours of rash onset (SWAT) was weak [43.6%] vs. Control [57.2%]).
- Overall, 90.9% (n = 20) of practices distributed intervention materials to staff; the average percentage of posters displayed was 81.1%; and in practices that examined at least one patient, there was a weak positive correlation between the implementation rating and the primary outcome (correlation coefficient 0.31).
- Qualitative interviews (12 practice staff) revealed uncertainty regarding engagement with materials and the inability to see SWAT as an effective intervention.
IN PRACTICE:
„Practice staff did not perceive the intervention as effective, and given their already high workload, it was sometimes deemed not worthwhile,“ the authors write. „Attempting to improve reception staff knowledge to lead to improved patient care… is unlikely to be successful.“
SOURCE:
The study was led by Elizabeth Lovegrove, BSc, BMBS, MRCGP, at the University of Southampton, Southampton, UK, and appeared online in the British Journal of General Practice.
LIMITATIONS:
Limitations included missing data, overestimated practice involvement with the resource, and limited performance.
DISCLOSURE:
The study was funded by the National Institute of Health and Care Research. The authors reported no conflicts of interest.