Improving early management through development of a compound intervention
Based on findings in Theme 1, we will develop interventions in collaboration with service users and providers and following the MRC framework for complex interventions. Service improvement interventions will be designed to tackle two problems; underuse of LP and inadequate laboratory methods, which together lead to the high incidence of wrong diagnosis. In the UK, we have shown that the introduction of a simple LP pack, with the appropriate equipment and guidance, greatly improved the uptake and performance of this investigation, e.g. increasing the percentage of patients with a PCR diagnosis from 17% to 50% . We will investigate its use in LMIC settings.
Our programme includes training in microbiological capabilities (see below); infrastructural constraints that limit performance, which will also be addressed. We will pilot these interventions with a view to more extensive roll out in a cluster study for which we will seek follow-on funding. In the longer term we will look at how implementations may be modified according to local need and replicated in different settings.
13. Michael BD, Powell G, Curtis S, et al. Improving the diagnosis of central nervous system infections in adults through introduction of a simple lumbar puncture pack. Emerg Med J 2013; 30: 402-5.