Sepsis risk factors and implications for primary care

Sepsis management is a critical aspect of patient care and safety, and practice managers play a pivotal role in ensuring that their healthcare facilities are prepared to identify, treat, and prevent sepsis effectively.

 CREDIT: This is an edited version of an article that originally appeared on GP Online

Sepsis, a condition where the body’s response to an infection spirals out of control, claims the lives of over 11 million people worldwide annually. As a practice manager, sepsis management is pivotal to safeguard patient well-being, ensure compliance with healthcare regulations, and allocate resources effectively.

In a joint venture between the University of Manchester and the UK Health Security Agency, a research initiative set out to unravel the connection between clinical risk factors, health inequalities, and the management of sepsis within diverse patient cohorts.

Two extensive case-control studies conducted in England formed the backbone of this investigation. Case-control studies compare individuals with sepsis to matched counterparts without the condition, pinpointing disparities in risk factors like socioeconomic status and ethnicity.

The socioeconomic struggle

Within a vast pool of 60 clinical characteristics, a compelling pattern emerged. Patients from the most deprived backgrounds exhibited a higher incidence of alcohol-related issues, chronic obstructive pulmonary disease (COPD), and severe mental illness or learning disabilities., these factors emerged as potent catalysts for community-acquired sepsis.

Among individuals of non-White ethnicities, a higher prevalence of anaemia, diabetes mellitus, chronic liver disease, severe mental health issues, and visual impairment surfaced as potent risk factors for sepsis.

Anaemia, chronic heart diseases (including atrial fibrillation, heart failure, and ischaemic heart diseases), and Parkinson’s disease exhibited substantially higher prevalence rates compared to their non-frail counterparts. These too stood out as formidable sepsis risk factors.

Risk prediction models

The development of risk prediction models achieved impressive discrimination, boasting c-statistics between 0.75-0.80. These models harnessed data on age, sex, chronic illnesses, deprivation status, historical antibiotic usage, and learning disabilities, all without factoring in indicators of infection severity.

Antibiotics in primary Care: A double-edged sword

As we know, although antibiotics wield power in averting infection and complications, there’s growing concern that indiscriminate antibiotic use may breed bacteria resistant to these life-saving drugs. Furthermore, their current prescription in primary care seldom accounts for a patient’s vulnerability to severe complications. This suggests that improved precision and risk-focused antibiotic prescription for common infections may become necessary.

Charting a new course: Policy priorities for primary care

In light of these revelations, the following policy priorities are proposed to stem the tide of sepsis in primary care, while considering health inequalities:

1. Precision antibiotic prescribing: Prioritise risk-based antibiotic prescribing for self-limiting bacterial infections, incorporating risk prediction models that consider infection severity, age, sex, chronic diseases, and indicators of reduced healthcare access and overall health.
2. Quality-driven initiatives: Integrate common infection management into the Quality and Outcomes Framework (QOF) or similar incentive schemes, particularly for practices serving populations with elevated indicators of reduced healthcare access and poorer health outcomes.
3. Remote monitoring: Implement remote monitoring to track the progression of common infections in high-risk patients prone to infection-related complications.
4. Guideline enhancement: Strengthen existing National Institute for Health and Care Excellence (NICE) treatment guidelines for common infections by offering guidance on addressing frequent clinical challenges, including patients receiving multiple antibiotic courses over time.
5. Learning healthcare system: Establish a Learning Healthcare System for common infections, equipping clinicians with tailored feedback regarding challenges within their practices. Moreover, provides personalised information to both patients and clinicians during consultations to facilitate shared decision-making.

These insights can provide practice managers with valuable strategies and policy priorities to enhance sepsis management, ultimately fostering safer and more effective patient care while addressing the challenges of health inequalities within their healthcare facilities.