Case study

Community pathway torapidly test and treat flu
Pathway project evaluation between Innovation
Agency, the Academic Health Science Network for theNorth West Coast (IA), Roche Products Limited andRoche Diagnostics Limited

Case study
Community pathway to rapidly test and treat flu

Summary
The purpose of the project was pathway service evaluation. We aimed to demonstrate whether using rapid diagnostics to diagnose Flu A/B and SARS-CoV-2 alongside
digital reporting in the community could improve patient outcomes, reduce the need for hospitalisations and therefore reduce the burden on secondary care, whilst
identifying any further system benefits.

Introduction
The pilot began as a collaboration between Innovation Agency, the AcademicHealth Science Network for the North West Coast (IA), Roche Products Limited
and Roche Diagnostics Limited. A Project Manager from IA and a Market Access
Manager from Roche Diagnostics were assigned from the outset to lead theproject.
Engagement with NHS stakeholders across the North of England in Spring
2021 involved communication with GPs, infection prevention control nurses,
pharmacists, care home managers, public health teams, commissioners,
information governance, digital leads, business and finance managers,
medicines management, regional academic health science networks andpatients. This enabled better understanding of current systems, the ability toidentify gaps and changes required, whilst also creating opportunities to gain
insight from wider teams.
Three Primary Care Networks (PCN) (Healthier South Wirral x6 GP surgeries;
Priory Medical Group York x8 GP surgeries; Valleys Health and Social Care x2
GP surgeries) agreed to participate. Working collaboratively, individualised
pathways were designed for each community location in which testing would
take place (GP surgeries, care homes, respiratory hubs, home visits).

A digital solution was a priority for sites. HealthCall, an NHS-owned company, wascommissioned to build a digital reporting pathway to suit multi-site requirements,
streamline processes and capture vital project data. Test results and National
Early Warning Score (NEWS2) scores were recorded directly on electronic patient
records to support appropriate treatment decisions. Information governance wasassured via robust data protection agreements and sharing protocols.
Independent evaluation was commissioned from Unity Insights providing realword evidence through a mixed methods evaluation. A quantitative analysis ofactivity data and outcomes demonstrated the cost and health benefits, while aqualitative analysis (patient and staff surveys, as well as semi-structuredinterviews) provided information on additional benefits. Finally, a budget impact
model was developed to help demonstrate the potential impact which could beobserved in other areas, should it be taken up more widely.
The project start date of December 2022 was planned to coincide with theannual Chief Medical Officer (CMO) letter outlining approval for the use of flu
antivirals in the community. The project ended in March 2023, earlier than
expected due to the rapid decline in flu numbers.

“I could be confident knowing whether it was flu or covid”“I felt glad to have a confirmed diagnosis of why I felt the way I did, it was really helpful”

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Community pathway to rapidly test and treat flu

Executive overview

Challenges

ResultWe originally planned to go live with the pilot in Winter 2021 but due torising omicron numbers and low flu circulation we decided to postpone until
Winter 2022 as we recognised flu was not a priority for our pilot sites at thistime – on reflection this gave us more time to implement the digital reporting
pathway and support pilot sites further.

In total, 250 at risk patients were tested across all sites, with a 12.4%
positivity rate (31 cases) for flu A; 1.2% positivity rate for flu B (3 cases)
and 10.4% positivity rate for SARS - CoV 2 (26 cases) using the cobas®
Liat system.

It was a challenge to consult stakeholders in each region to gain approvals
as this was during a time of significant change and reorganisation within thenew integrated care board implementation. We organised an all sites‘knowledge sharing day’ and used this opportunity to narrow down andidentify key stakeholders and support each site in meeting with them all.
A further challenge was bringing together all legal requirements for dataprocessing across all sites and partners. This turned out to be quite alengthy process and a steep learning curve for us all and involved drafting
contracts and detailed data protection impact assessments to cover data
usage/ sharing and patient confidentiality. Once this was completed it
provided confidence that the project was compliant and the planned go-live
date could be met.

Of the patients who tested positive for flu, 23 were prescribed antivirals
and six were prescribed antibiotics. There were two attendances at
Accident & Emergency (A&E) - both patients had tested positive for flu A in
primary care. Both patients had received treatment in the community; one
required hospital admission via A&E.

“The test was very quick and easy to do. I wasinformed that my test was clear promptly”“It was good to know in 20 minutes that I had flu”

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Community pathway to rapidly test and treat flu

Healthcare Professional feedback
Key feedback themes were identified
including timing, project support andcommunication.
Results from an initial survey which wasreleased to a range of relevant job roles at
all three pilot sites indicated that thepathway was easy to understand, and thatthe test was easy to administer. Quick
diagnosis [20 minute test to result time] andappropriate treatment were identified as keyclinical and patient benefits.
The support which proved most effective
was regular contact with the project leads
and working with other teams.
Following analysis of the survey results,
semi-structured interviews were arranged
with a lead clinician and the person who
provided managerial or administrative
support at each of the pilot sites to ensure
we captured different perspectives and put
the results of the survey into context.
When asked about an “ideal” timeframe forplanning and launch, the answers varied
significantly, but all agreed that planningshould start as early as possible.

The main issue identified was the need tolaunch the pathway once the letter from theCMO was published. This was required as astarting point as the letter authorises use ofantivirals for flu management in thecommunity. A key theme from the interviews
was that those sites with strong working
relationships with pharmacies or who wereable to leverage support from their PCN had
fewer issues sourcing antivirals following a
positive test for flu.

“… The benefits we’re talking about
in terms of stopping that [carehome] outbreak early, you canreally make a big impact”

All sites noted that the support provided by
the project leads were the key to success,ensuring that information flowed effectively
and that any emerging issues were dealt withpromptly.

The digital solution for recording test results,
sending the data to primary care systems, andsending prompts for follow-up was also covered
during the interviews. Two of the three pilot sites
used the digital solution and described it asinvaluable for embedding the pathway into
routine care and ensuring the correct steps weretaken. The site which chose not to use the digitalsolution instead developed their own system inhouse. This solution worked well for them but
had the original pathway (which would haveincluded community outreach testing) been
followed then their solution may have been
insufficient. It also requires having the resourceand skill to be able to build an in-house solution.

“…We’ve been supported
throughout the whole project”“… Could isolate them [diagnosedresidents] and stop flu spreading
through the care home”“...Patients do like certainty so still
having the message of it’s a virus
but it isn’t flu or COVID”

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Community pathway to rapidly test and treat flu

Patient feedback
All 250 patients in the pilot cohort were sent afeedback questionnaire; 30% of patients
responded. Below is a representative sample offeedback quotes.

We approached the project through a service
evaluation. Multiple sites were considered for
demographic variation and consideration ofsocio-economic factors.

“As a result of a positive test I wasgiven an antiviral drug and waswell very quickly”

The project was underpinned by three key
features:“Originally I contacted the GPwith a possible chest infection, but
was channelled into flu testing”•Project management - structure anddedicated resource, accountability andprioritisation.

•Contractual structure – Roche Products
Limited and Roche Diagnostics Limited
contracted with Innovation Agency, theAcademic Health Science Network for theNorth West Coast (IA). The IA directly
contracted with all others involved(Regional academic health science
networks, NHS sites, HealthCall and Unity
Insights). This developed clear lines ofresponsibility, managed workload andtimescales.

•Collaborative learning and sharing –ensuring that all information wascoordinated and communicated rapidly toensure best practice and continuity ofservice.

Adoption andmethodologies
A mix of methods, including lean process
mapping, design-thinking and scenario planningwere used to help primary care sites design a fit
for purpose community pathway that could bereplicated or adapted to suit different needs.
The project also included qualitative interviews
and quantitative analysis of the data post pilot
to provide evidence and feedback to support
further optimisation and scalability in the future.

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Case study
Community pathway to rapidly test and treat fluOutcomes
The project demonstrates that a community flu test and treat pathway,
including rapid diagnostics, digital development and connectivity, can besuccessfully established, implemented and replicated across multiple
locations, with the critical factors being cooperation and collaboration fromall partners involved. Specifically, the pilot has shown that:•A community test and treat pathway improves patient care by providing
an early diagnosis thus facilitating the prevention of deterioration
through appropriate treatment in primary care and potentially reducing
the burden on secondary care.

•The pathway is easy to understand and access from a patientperspective; additional information from the GP surgery about earlypresentation with symptoms may encourage patients to access services
within the 48-hours of onset of symptoms.

•The pathway is efficient from a primary care workload perspective,
utilising appropriately qualified healthcare professionals in the pathway.

•The pathway is easily adaptable across a range of different community
health settings.

•The pathway gives prescribers diagnostic certainty enabling evidencebased conversations with patients about appropriate medicationrequirements, which may reduce antibiotic requests, improving
confidence in both prescribers and patients.

“The very thorough and quick response was excellent. I wasasked to go in and see the GP at the surgery. Was thoroughly
checked over and the test was done there and then. I returned
home and was telephoned by the GP to confirm that I had flu.
Medication arranged. Although I got a secondary infection I
was relieved I had got the care from my GP's surgery at theoutset. Extremely satisfied with the service”

Next steps•

Continue conversations with strategic partners to explore how the pathway
may be adopted and scaled across the UK.

•Develop an implementation guide, outlining the key success factors for similar
collaborative work across remote sites with multi-disciplinary teams.

•Publish the findings and finalise the budget impact model to support
implementation in other sites.

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7©2023 Roche Diagnostics Limited. All rights reserved. LIAT and COBAS are trademarks of Roche. Allother product names and trademarks are the property of their respective owners.
Roche Diagnostics Limited
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Company Registration Number: 571546
Date of preparation: May 2023
Document number: MC-IE-02170
For healthcare professional use only in the UK and Ireland.
diagnostics.roche.com©2023 Roche Products Limited. All rights reserved. LIAT and COBAS are trademarks of Roche. All otherproduct names and trademarks are the property of their respective owners.
Roche Products Limited
Hexagon Place, Shire Park, Falcon Way, Welwyn Garden City, AL7 1TW
Company Registration Number: 00100674
Date of preparation: May 2023
Document number: M-GB-00012380
For healthcare professional use only in the UK and Ireland.
roche.com©2023 Innovation Agency, the Academic Health Science Network for the North West Coast.
Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE
Company Registration Number: 212330696
For healthcare professional use only in the UK and Ireland.
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