Primary Care Monitoring of Community Acquired Clostridia difficile Jean Matthews Aneurin Bevan University Health Board ASF November 2104

Definitions adapted from Kypers et al 2006 – hospital acquired takes into account 3months prior to diagnosis

Community Acquired Clostridia difficile ABUHB CD cases 53% reduction target April 2103 – increased focus on primary care In-depth review of primary cares Significant event reporting (Datix) Collect data on antibiotics prescribing, PPI (H2s) steroids, other relevant data (allergy, e-GFR) Previous hospital admissions, care home patients etc

CD Monitoring in Primary Care: April 2013 – September 2014 No. of Community Acquired Cases 88 % Forms returned 67 76% Patients in care home 12 14% Patients with previous hospital admission within 3 months 24 42% Patients taking PPIs 25 37% Patients taking H2 antagonist 1 1.5% Patients taking oral steroids in previous 12 months 13 19% One course of steroids 4 31% Two courses of steroids 3 23% Three + courses/Long term 6 46% Patients receiving antibiotics within 3months before diagnosis 40 60%

Age range of patients 68% of cases over 70

37% of patients receiving PPI 1.5% of patients receiving H2 antagonist Laxative data now being requested 42% patients had hospital admission up to 3 months prior to diagnosis (N=57)

19% patients had oral steroids within previous 12 months (N=67) Of these 19%

Number of criteria being met per case Antibiotics/hospital admission/PPI/steroids

Cases per GP Practice (N=86 cases)

Practice variation: One case per ‘x’ 1000 PU Variation Higher the better

Conclusions Monitoring raised awareness of community acquired cases with GPs Feedback to GPs highlights “typical” risk factors and discussions on antibiotic guidance Highlights the need for holistic perspective rather than a primary or secondary care issue. No clustering evident – similar numbers in each GP NCN cluster Next stage: NCN feedback correlated with antibiotic use

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