Primary Care Research Centre, University of Southampton, Southampton.
Bristol Trials Centre, University of Bristol, Bristol.
Br J Gen Pract. 2024 Aug 29;74(746):e644-e651. doi: 10.3399/BJGP.2023.0477. Print 2024 Sep.
Herpes zoster (shingles) is normally diagnosed clinically. Timely diagnosis is important so that antiviral treatment can be started soon after rash onset.
To assess whether a practice-level educational intervention, aimed at non-clinical patient-facing staff, improves the timely assessment of patients with shingles.
This was a cluster randomised study within a trial (SWAT) with nested qualitative study in general practices in England.
Practices were cluster randomised 1:1, stratified by centre and minimised by practice list size and Index of Multiple Deprivation score. Intervention practices were sent educational materials, highlighting the common presenting features of shingles and what action to take if suspected. The primary and secondary outcomes were the mean proportion of patients per practice seen within 72 and 144 h of rash onset, respectively. Comparison between groups was conducted using linear regression, adjusting for randomisation variables. Semi-structured interviews with practice staff in intervention practices explored views and opinions about the intervention.
In total, 67 practices were enrolled; 34 randomised to the intervention and 33 to the control. The mean difference in proportion of patients seen within 72 and 144 h was -0.132 (95% confidence interval [CI] = -0.308 to 0.043) and -0.039 (95% CI = -0.158 to 0.080), respectively. In intervention practices, 90.9% reported distributing the educational materials; however, engagement with these was suboptimal. Twelve participants were interviewed, and the poster component of the intervention was said to be easiest to implement.
Our educational intervention did not improve the timely assessment of patients with shingles. This may be the result of poor intervention engagement.
带状疱疹（带状疱疹）通常通过临床诊断。及时诊断非常重要，以便在皮疹发作后尽快开始抗病毒治疗。
评估针对非临床面向患者的一线员工的实践层面教育干预是否能提高带状疱疹患者的及时评估。
这是一项在英格兰普通诊所进行的随机对照试验（SWAT）内的群组随机研究，其中嵌套了定性研究。
实践随机分为 1:1 组，按中心分层，并根据实践列表大小和多重剥夺指数最小化。干预实践收到了教育材料，突出了带状疱疹的常见表现特征以及如果怀疑出现的症状该采取的措施。主要和次要结局分别是每个实践中皮疹发作后 72 和 144 小时内就诊的患者比例。使用线性回归调整随机化变量比较组间差异。对干预实践中的实践人员进行半结构化访谈，探讨他们对干预的看法和意见。
共有 67 家诊所参与，34 家随机分为干预组，33 家分为对照组。皮疹发作后 72 小时和 144 小时内就诊的患者比例平均差异分别为 -0.132（95%置信区间[CI] = -0.308 至 0.043）和 -0.039（95% CI = -0.158 至 0.080）。在干预实践中，90.9%的人报告分发了教育材料，但参与度不理想。对 12 名参与者进行了访谈，海报干预措施被认为是最容易实施的。
我们的教育干预并未改善带状疱疹患者的及时评估。这可能是由于干预措施参与度低所致。
