Not all research is about making discoveries: transitioning from scientific jargon to comprehensible guidance

Dr Donna M Lecky, Public Health England and Sarah Alton, Public Health England

Some of the most important research carried out in recent years to facilitate antimicrobial stewardship has been the development of comprehensible, quick reference national diagnostic and management of infection guidesas a tool for primary care prescribers. The guidance aims to minimise the emergence of antimicrobial resistance in the community by improving the diagnosis of common infections, increasing understanding of microbiology results and listing the most appropriate treatment for the management of common infections seen in primary care. In short, the guidance reviews and condenses all the evidence into a very short quick reference guide for prescribers to use during consultations.

Why was the guidance developed?
In order to involve the primary care sector in the setting research and development priorities, a questionnaire survey of GPs was used by the PHLS in 1998 to gather their views of the burden of different infectious diseases and the priorities for research and guidance development. 2 The survey allowed the PHLS Primary Care Unit (now the Public Health England Primary Care Unit to prioritise their research and guidance development. Genital chlamydia infections, antibiotic resistance surveillance, vaginal discharge and otitis media/externa were within the top 10 illness/conditions prioritised for improvement in diagnostic tests, the need for more evidence on which to base management, and guidance. The first guidance was created in 1999 in response to this research.

How are the current quick reference guides developed?

The guidance has evolved throughout the years and is now a widely used resource, in its original and locally adapted form, across Primary Care networks. To ensure reliability, accuracy and functionality, guidance development follows a rigorous 6-step process:

1. Needs assessment: scope suggested topics through focus groups with users and external stakeholders.

2. Search strategy: the PICO (Population Intervention Control/Comparison Outcome) model is used to develop search questions for each condition included in the guidance.

3. Literature search: follows a three-stage search protocol

a. Existing guidelines are reviewed.
b. Search bibliographic databases for relevant primary research.
c. Expert opinion is sought from relevant specialists where published recommendations are not available.

Studies are prioritised based on the robustness of data within i.e. systematic reviews and meta-analyses down to case reports or case series.

4. Draft guidance: All evidence for the included recommendation is accompanied by a rationale for inclusion and strength of recommendation grading according to the quality of the evidence (A+ for systematic reviews and meta-analyses through D for a formal combination of expert opinion).

5. Review and modify: Primary care clinicians, patient representatives, and professional bodies review and give advice on the draft guidance. The review and modification process is cyclical, and this can go back and forth between the research team and external reviewers’ countless times before consensus is achieved.

6. Publish: Approval is sought from various PHE communications departments prior to publishing.

What’s happening next?

Public Health England (PHE), in collaboration with the RCGP, would like to invite you take part in a survey (click here) to identify for which conditions you would like to see more evidence for management in your daily clinical practice. The survey takes 7 minutes to complete and your response will be used to determine where research is needed to inform guidance development. On completion, you will have the opportunity to enter your details into a draw to win one of four sets of £50 John Lewis or Debenhams vouchers.

References:

1. Management of infection guidance for primary care for consultation and local adaptation. https://www.gov.uk/government/collections/primary-care-guidance-diagnosing-and-managing-infections
2. McNulty CAM, Smith GE and Graham C. PHLS primary care consultation – infectious disease and primary care research and service development priorities. Comm Dis Public Health. 2001. 4:18 – 26.  

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