Dr Ashton Harper, head of medical affairs, Roche Diagnostics UK and Ireland, outlines a pilot worked on by the company involving flu testing.
Shutterstock
2182188713
People showing influenza symptoms
Most years, flu is a major contributory factor to the “winter pressures” narrative; flu affects 5-10% of adults and 20-30% of children globally each year. This then plays out across the NHS, as winter pressures faced by the NHS are often exacerbated by cases of seasonal influenza. Yet it feels like we repeat the same mistakes – diagnosing flu and other respiratory diseases too late, when patients are already acutely unwell. Flu can often be missed in hospital because people admitted with severe respiratory symptoms are not always tested for it, and once someone has been hospitalised they can of course spread the disease to other people who may be clinically at risk of respiratory disease.
Roche Diagnostics has a heritage of working in the infectious diseases space, and there are tests available that can diagnose flu in as little as 20 minutes, and antiviral treatments which can reduce the risk of patients becoming seriously unwell. From that position we developed the premise for a new test and treat pilot with a working hypothesis that if patients with flu-like symptoms were diagnosed earlier, the right treatment interventions could be made at the right time which could, in turn, help to alleviate pressure on the parts of the health system where flu often has the greatest impact, such as general practice and hospital Emergency Departments.
We know from experience that the key to getting innovation to the people who need it, in a way that makes most sense to the whole health system, is partnership working. So in collaboration with the Innovation Agency the Academic Health Science Network (AHSN) for the North West Coast, York and Humber AHSN, Unity Insights, Health Call and our colleagues in Roche Products we designed a flu test and treat community pathway which we piloted in locations across Yorkshire and the North West of England last winter. Our objective was to assess whether using rapid diagnostics early in the pathway, to identify patients who would potentially benefit from being prescribed appropriate treatment for flu, alongside digital reporting in the community, could improve outcomes, reduce hospitalisations, and therefore reduce the burden on secondary care.
The pathway was piloted at sixteen participating sites including Priory Medical Group, York, Healthy South Wirral Primary Care Network, Oaklands and Slaithwaite Health Centres and several residential care homes from December 2022 to March 2023.
A target population of around 43,000 clinically at-risk patients were invited to have a test upon developing flu symptoms. The results of the pilot were as follows: Out of 250 at-risk people tested for flu, 33 tested positive, with 23 then prescribed antivirals and six prescribed antibiotics. Based on national averages for flu surveillance, an estimated 17 hospitalisations, four deaths, and one ICU admission were avoided due to the pilot. In addition, based on NHS costs details, we estimate that there is a potential cost saving from the pilot of £37,000 on avoided hospital admissions, and around £1,000 in avoided intensive care unit (ICU) admission costs.
The best proof of concept for the value of rapid testing at the point of care was the COVID-19 pandemic, when industry worked in partnership with the NHS and government to make the latest testing technology available and easily accessible to everyone. Our flu pilot builds on this approach and provides further evidence that this type of collaboration can be applied to help combat other significant health challenges.
Partnerships like these are not without their challenges, none more so than finding capacity in the NHS workforce to help develop and deliver innovations. But there is also a growing consensus that diagnostics, deployed in the right setting at the right time, can play an important role in population health, which can in turn relieve pressure on the system in the short, medium, and longer term. Which is why we need to keep working together to shift the model from a predominantly reactive one which waits for people to become ill, to a more proactive one which catches them earlier and even prevents them from becoming ill at all.
