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

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

3. 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

4. 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%

5. Age range of patients
68% of cases over 70

8. 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)

9. 19% patients had oral steroids within previous 12 months (N=67)
Of these 19%

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

11. Cases per GP Practice (N=86 cases)

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

13. 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

14. Any questions?