Mapping and comparing COPD Care Pathways across 10 countries to understand barriers to optimal care: clinicians’ perspectives

Although predominantly preventable and treatable, chronic obstructive pulmonary disease (COPD) is a leading cause of death globally (1). Guidelines for managing the condition are widely available (2), yet, COPD care remains suboptimal in many settings, including high and middle-income countries (3).

Concerted regional or global efforts in COPD care may lead to important synergies in improving outcomes for patients across many healthcare settings. To achieve this, researchers and policymakers must gain a better understanding of the extent to which countries share common barriers.

Aquarius Population Health led a multifaceted project that used published literature and clinical guidelines to map the COPD care pathways in 10 countries: Argentina, Australia, Canada, England, Germany, Japan, Mexico, Russia, Spain, and Taiwan. To validate the pathways and understand how clinicians perceive barriers to optimal COPD care, we spoke to 41 healthcare professionals across all these countries. Finally, we combined all the data and compared the pathways, to see how different or similar are barriers to COPD among the studied countries.

The results of this work indicate that regardless of differences in economic development or healthcare systems among countries, many issues in COPD care are quite similar. Further efforts are needed to address these issues at a global level. The poster reporting this work is published at the 11th IPCRG World Conference and can be accessed here.

Shahaj O, Meiwald A, Gara-Adams R et al. Mapping and comparing COPD Care Pathways across 10 countries to understand barriers to optimal care: clinicians’ perspectives.” Presented at: 11th IPCRG World Conference, May 5-7 2022; Virtual

1.           Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020 Oct;396(10258):1204–22.

2.           Singh D, Agusti A, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J [Internet]. 2019 May 1 [cited 2022 Jan 19];53(5). Available from: https://erj.ersjournals.com/content/53/5/1900164

3.           Young M, Villgran V, Ledgerwood C, et al. Developing a Multidisciplinary Approach to the COPD Care Pathway. Crit Care Nurs Q. 2021 Mar;44(1):121–7.

© Aquarius Population Health 2022. For commercial use or distribution, please contact info@aquariusph.com.

Further evidence that rapid near-patient testing for chlamydia and gonorrhoea in sexual health clinics benefits patient care

Chlamydia and gonorrhoea are among the most common sexually transmitted infections (STIs) and around 2 million people are tested for chlamydia and gonorrhoea in sexual health services (SHSs) each year in England [1].

The turnaround time for test results can vary from 1-2 days in many urban clinics to more than 8 days in some areas [2-4]. This means that instead of waiting for the result before treating people, many clinics choose to treat patients when they first attend if they have symptoms, or their partner has a confirmed infection. Inevitably, this means that some people without an infection receive antibiotics whilst people with an infection, but no symptoms must return to receive treatment on a subsequent day, risking onward transmission in the meantime.

In an Innovate UK grant-funded project, Aquarius Population Health collaborated with three sexual health clinics in England to develop evidence around the impact of using a new highly accurate 30-minute point-of-care test for chlamydia and gonorrhoea developed by binx Health.

The results of this work indicate that compared to using standard laboratory tests, using a 30-minute point-of-care test reduces waiting times for test results and time to chlamydia treatment. The paper reporting this work is published in Therapeutic Advances in Infectious Disease and the full text can be accessed here.

Huntington S, Weston G, Adams E. Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services. Therapeutic Advances in Infectious Disease. January 2021. doi:10.1177/20499361211061645

References

  1. Public Health England. Sexually transmitted infections and screening for chlamydia in England, 2020. Available online.
  2. Public Health England. Audit report on turnaround times National Chlamydia Screening Programme. [Internet]. 2014 Nov. Available online.
  3. Harding-Esch E, Sherrard-Smith E, Fuller SS, et al. P65 Sexual behaviour in the time period between being tested for chlamydia and receiving test result and treatment. Sex Transm Infect [Internet]. 2015 Jun 1 [cited 2019 Feb 27];91(Suppl 1):A37–A37. Available online.
  4. British Association for Sexual Health and HIV (BASHH). Standards for the management of sexually transmitted infections (STIs) (Draft for public consultation) [Internet]. 2019 Jan. Available online.

© Aquarius Population Health 2022. For commercial use or distribution, please contact info@aquariusph.com.

Evidenced Care Pathways (ECPs) for chronic obstructive pulmonary disease in Japan, Canada, England, and Germany

Chronic obstructive pulmonary disease (COPD) is a preventable, progressive respiratory disease that causes considerable morbidity and mortality worldwide (1).

Despite the availability of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations for COPD management (2), there remains uncertainty around how care is currently delivered within individual countries and what barriers exist to the optimal delivery of COPD care.

Aquarius Population Health collaborated with AstraZeneca to create Evidenced Care Pathways (ECPs) to bring to life the story of how COPD care is currently delivered. Local data reviews and clinician interviews (twenty-four respiratory healthcare professionals in primary and secondary care) were used to inform and validate the ECPs.

The ECPs are a valuable tool in healthcare evaluation and were used to help identify the key barriers for optimal COPD care, and therefore opportunities for policy change – to improve disease awareness, care management and patient outcomes while reducing resource use and costs. The results of our research are published in the International Journal of Chronic Obstructive Pulmonary Disease] found here. These ECPs for COPD care in Japan, Canada, England, and Germany accompany the published paper.

Meiwald A, Gara-Adams R, Rowlandson A, et al. Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care. Int J Chron Obstruct Pulmon Dis. 2022;17:1507-1521 https://doi.org/10.2147/COPD.S360983

VIEW ECP

1. Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis. J Glob Health. 2015;5(2):020415.

2. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2021 Report. 2021.

© Aquarius Population Health 2021. For commercial use or distribution, please contact info@aquariusph.com.

Care Pathway Mapping for Dravet Syndrome (DS) Patients in England

Dravet syndrome (DS) is a rare, early onset, lifelong, epileptic encephalopathy characterised by frequent and severe convulsive seizures. Finding effective treatments is imperative to reducing seizures and improving patient outcomes: DS is highly burdensome for both the patient and their family as well as the healthcare system.

It is important to understand how care is currently delivered to children and adults to improve care to meet the needs of DS patients. Aquarius Population Health presented the results of our pilot study at this year’s ILAE British Branch Virtual Annual Scientific Conference. We describe how care for people with DS is delivered across England and determine the utilisation of healthcare resources for the treatment of patients with DS, and the effects of seizure burden and age group.

Gara-Adams R, Mowlem F, Thomas RH, et al. Care Pathway Mapping for Dravet Syndrome (DS) Patients in England – interim results from a pilot study. Presented at: ILAE British Branch Virtual Annual Scientific Conference, September 23 – 24, 2021; Virtual

Analysing the COPD care pathway in Japan, Canada, England, and Germany: a global view

Chronic obstructive pulmonary disease (COPD) is a preventable, progressive respiratory disease that causes airflow blockage and breathing problems. COPD caused 3.23 million deaths in 2019 (1), affecting approximately 384 million people globally (2); and is associated with significant resource burden with global costs estimated to be US$2.1 trillion in 2010, rising to US$4.8 trillion by 2030 (3).

Despite the availability of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations for COPD management, there remains uncertainty around how care is currently delivered within individual countries and what barriers exist to optimal COPD care delivery.

Aquarius Population Health collaborated with AstraZeneca to present our research at a poster session at this year’s European Respiratory Society International Congress. Based on clinician interviews and local data reviews, our research advances our understanding of COPD care pathways in Japan, Canada, England, and Germany and identifies cross-cutting barriers to optimal COPD care. Opportunities for policy change were highlighted – to improve disease awareness, care management and patient outcomes while reducing resource use and costs.

Meiwald A, Gara-Adams R, Ma Y, et al. Analysing the COPD care pathway in Japan, Canada, England and Germany: a global view. Presented at: European Respiratory Society International Congress 2021, September 5 – 8, 2021; Virtual

1.  WHO. Chronic obstructive pulmonary disease (COPD) fact sheet. 2021

2. Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis. J Glob Health. 2015 ;5(2):020415.

3.  Bloom DE, Cafiero ET, Jané-Llopis E, et al. The Global Economic Burden of Noncommunicable Diseases. Geneva; 2011

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A cost effectiveness analysis of repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK

Syphilis is a treatable sexually transmitted infection (STI) which can be passed from mother to foetus during pregnancy resulting in congenital syphilis. Syphilis infection also increases the risk of adverse pregnancy outcomes such as stillbirth and pre-term delivery. Most cases of congenital syphilis and adverse pregnancy outcomes can be avoided if the infection is diagnosed and correctly treated during pregnancy.

In the UK, pregnant women are offered screening for syphilis, HIV and hepatitis at their first antenatal appointment, typically at or before 12 weeks gestation. Despite the very high coverage of these routine screens plus repeat screening in some higher risk women, a handful of congenital syphilis cases still occur each year, either in women who miss screening or in women who become infected with syphilis after their antenatal screen. For this reason, the UK National Screening Committee (UK NSC) commissioned Aquarius to assess the cost effectiveness of offering a repeat screen to all pregnant women later in pregnancy.

We worked closely with a small group of experts to compare the current strategy – screening in the first trimester only – with an alternative strategy – screening in the first trimester and a repeat screen later in pregnancy.  We developed a decision tree and model inputs which accounted for the sensitivity and specificity of the syphilis assay, the small number of women who do not attend antenatal care until their third trimester (thereby missing the opportunity for repeat screening) and the costs associated with screening, delivery and antenatal care for all women delivering in the UK in one year.

The model revealed that repeat screening would prevent 5.5 cases of congenital syphilis each year but at cost of £1.8 million per case avoided. When a lifetime horizon was considered, the incremental cost-effectiveness ratio (ICER) for the repeat screening strategy was £120,494 per QALY gained – well above the £20k-30k cost per QALY threshold that NICE uses to assess interventions.

The paper concludes that in the UK setting, where prevalence of syphilis is very low, repeat screening for syphilis in pregnancy would not be a cost-effective strategy and alternative strategies should be sought to prevent congenital syphilis.

This is the first published study from outside the US to compare these two screening strategies. The results will be used to inform national screening policy and are relevant countries with similar syphilis prevalence and healthcare costs. 

Huntington S, Weston G, Seedat F, et al Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis BMJ Open 2020;10:e038505. doi: 10.1136/bmjopen-2020-038505

Cost-effectiveness and impact of five different point of care strategies to preserve last line treatment for gonorrhoea

Antimicrobial resistance (AMR) has developed to every class of antibiotic used for the treatment of gonorrhoea – and in recent years several multi-drug resistant strains of gonorrhoea have been reported in the UK and elsewhere. Once the prevalence of resistance to a first-line treatment reaches 5%, an alternative drug is selected as first-line treatment. In the UK, as with many other countries, ceftriaxone is the current first-line treatment for gonorrhoea. There are few alternative treatments available should ceftriaxone resistance become widespread and therefore steps are being taken to preserve the effectiveness of ceftriaxone by avoiding its use for infections that could be treated using other antibiotics.

Aquarius was commissioned by the Applied Diagnostic Research and Evaluation Unit (ADREU) at St. Georges London to compare the cost and effectiveness of five different strategies to test for antibiotic susceptibility in NG infections. We developed a decision tree model to assess how point-of-care (POC) testing could be used to diagnose gonorrhoea and at the same time test for antibody susceptibility, allowing the use of previously abandoned antibiotics for the majority of patients, thereby sparing ceftriaxone use.

The results of the model showed that all five strategies cost more than the current strategy of not testing for AMR. The paper concludes that AMR POC testing may enable improved antibiotic stewardship but would require investment into the health system.

The article was published in October in Eurosurveillance and is available free online [link].

Harding-Esch EM, Huntington SE, Harvey MJ, Weston G, Broad CE, Adams EJ, et al. Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics. Eurosurveillance [Internet]. 2020;25(43). Available from: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.43.1900402

Cluster-randomised feasibility trial of a chlamydia test and treat (TnT) service in further education colleges

Aquarius were involved in a recent cluster-randomised feasibility trial looking at whether provision of a same day test and treatment (TnT) service for chlamydia in further education colleges could be used to improve uptake of chlamydia testing in sexually active 16-24 year olds. The trial found that despite a high prevalence of chlamydia among sexually active students at the colleges, uptake of the free confidential TnT service was low. At the three colleges, 13% of students were tested when the service was first offered and 10% when it was offered again three months later. Interviews with students revealed that low uptake was associated with not feeling at risk of a sexually transmitted infection, perceptions of stigma, and lack of knowledge about sexually transmitted infections, while all students interviewed were positive about the TnT service itself.

PublicationOakeshott P, Kerry-Barnard S, Fleming C, et al. “Test n Treat” (TnT): a cluster randomised feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges. Clinical Microbiology and Infection. https://doi.org/10.1016/j.cmi.2018.10.019.

Test n Treat – rapid STI testing and treatment in colleges: study protocol

Sexually active young people attending London further education (FE) colleges have high rates of chlamydia, but screening rates are low. We describe the study protocol for “Test and Treat” (TnT), an NIHR-funded research study. This is a cluster randomised feasibility trial of frequent, rapid, on-site chlamydia testing using the Cepheid GeneXpert system and same-day treatment in six FE colleges. As part of the study we also conducted qualitative and economic assessments to assess the feasibility of conducting a future large-scale trial to investigate if TnT reduces chlamydia rates. The methods for recruitment, participant data collection, sample collection and testing are described, for baseline and follow-up in the control and intervention groups. The statistical analysis plan for TnT has been published separately.

 

PublicationKerry-Barnard S, Fleming C, Reid F, et al. ‘Test n Treat (TnT)’- Rapid testing and same-day, on-site treatment to reduce rates of chlamydia in sexually active further education college students: study protocol for a cluster randomised feasibility trial. Trials. 2018 Jun 5;19(1):311. doi: 10.1186/s13063-018-2674-8.

To request a copy of the published article, please email caroline.dombrowski@aquariusph.com.

Exploring HCV eradication through diagnosis and treatment strategies

The World Health Organization aims to eradicate hepatitis C virus (HCV) by 2030. To achieve this, improved HCV diagnosis and treatment coverage are required. We explored the relationship between diagnosis and treatment in the next 5 years in Italy, France, and the UK to understand how to achieve the most benefit.

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Harvey MJ, Cheng C-Y, Leone E, et al. Exploring HCV eradication through diagnosis and treatment strategies. EASL Monothematic Conference, Striving Towards the Elimination of HCV Infection. 2-3 February 2018, Berlin, Germany.

 

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