Primary care research should lead future pandemic preparedness – PANORAMIC study report

The report recommends considering the use of UK-wide pharmacy networks to promote research inclusion in future primary care trials

The NIHR Research Delivery Network (RDN) has published a new paper highlighting the learnings from a major COVID-19 research trial conducted in primary care settings.

The paper, which draws on insights from the PANORAMIC study, emphasised the importance of prioritising primary care studies from the very start of any pandemic to prevent worsening of patient symptoms and reduce hospital admission.

Additionally, it recommended considering the use of UK-wide pharmacy networks, including community pharmacies, to promote research inclusion for future similar trials in primary care to increase recruitment in underserved communities.

Authored by Professor Phil Evans, GP and Deputy Health and Care Director at the NIHR RDN together with colleagues from the NIHR and University of Oxford, the 80-page paper concluded that primary care research should be at the forefront of future pandemic preparedness.

During the early stages of the COVID-19 pandemic, much research was carried out on critically ill patients in secondary care settings.

However, by spring 2021, it became evident that certain novel antiviral drugs required further evaluation within primary care.

This realisation led to the launch of the Platform Adaptive trial of NOvel antiviRals for eArly treatMent of COVID-19 In the Community (PANORAMIC) later that year.

The study, funded by the NIHR and delivered by the NIHR RDN alongside equivalent networks in the devolved administrations, was led by the University of Oxford.

The paper highlighted the role pharmacies played in the study, emphasising that they are “invaluable in reaching out to underserved communities including those living in areas of high deprivation.”

Major national pharmacy chains like Boots UK Limited and LloydsPharmacy UK, along with regional and small independent pharmacies, supported the PANORAMIC trial by promoting it through their outlets and websites using posters.

The PANORAMIC trial is considered to be the fastest-recruiting and largest trial of a therapeutic agent for COVID-19 ever conducted in primary care. The trial has also inspired similar studies worldwide, including the CanTreat COVID study in Canada.

Lead author, Professor Phil Evans, explained: “PANORAMIC recruited just under 30,000 participants into a randomised platform trial using innovative methods of recruitment - such as self referral through a website coupled with recruitment through a GP hub and spoke model - that had not previously been tested in a primary care setting.

“For this reason, PANORAMIC has been recognised globally as a trailblazing study for primary care, this is evidenced by the fact it has inspired a similar trial in Canada and the results have been used in other nations to inform policy.”

He mentioned that they have been transparent in this paper about both what went well and what didn’t go so well so that everyone is equipped to deal with similar situations in the future.

Based on the report's findings, 30 key recommendations were identified that could support the delivery of similar studies in a future pandemic environment. The full paper has been published on the NIHR Open Research website.