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Ghafoor S, Salvadori G, Kino S, Nguyen VTN, Nguyen TTT, Ishimaru M, Ricomini-Filho AP, Rösing CK, De Silva D, Aida J, Nicolau BF, Lalloo R, Junges R. Insights Into Antimicrobial Resistance From Dental Students in the Asia-Pacific Region. Int Dent J 2024:S0020-6539(24)01529-6. [PMID: 39370344 DOI: 10.1016/j.identj.2024.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/19/2024] [Accepted: 09/10/2024] [Indexed: 10/08/2024] Open
Abstract
BACKGROUND Dentists, as prominent prescribers, are key stakeholders in addressing the antimicrobial resistance (AMR) crisis. Dental students' perceptions about the topic have been underexplored in the Asia-Pacific region, a key location for the development and spread of AMR. Thus, the aim of this study was to evaluate the awareness and confidence to prescribe antimicrobials amongst dental students studying in the region. METHODS Students from 15 dental schools in 4 countries were invited to participate in a cross-sectional online survey during 2022-2023. A previously validated and standardised 14-item instrument was utilised. RESULTS In all, 1413 responses were collected from Australia (n = 165), Sri Lanka (n = 112), Japan (n = 173), and Vietnam (n = 963). Of those, 201 were from final-year students (14.2%). On a scale from 1 to 10, awareness on AMR was placed at a mean (SEM) priority of 8.09 (0.05). With regards to target areas to address for mitigation of the AMR crisis, participants placed general public awareness at the top (mean [SEM] 8.53 [0.05]). Final-year students presented a mean (SEM) level of confidence to prescribe antibiotics of 6.01 (0.14) on a scale from 1 to 10, whilst 59.7% and 56.8% indicated feeling pressured to prescribe by patients or when lacking time, respectively. Final-year students participating in research activities assigned a higher priority to AMR compared to their peers not involved in research (mean [SEM] 8.6 [0.19] vs 7.81 [0.16]; P = .01). CONCLUSIONS This study highlights a need for increased awareness and confidence to prescribe amongst dental students in the Asia-Pacific region, an understudied population thus far. To mitigate this issue, the implementation (followed by assessment) of local educational and antibiotic stewardship initiatives is warranted.
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Affiliation(s)
- Saba Ghafoor
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Gabriela Salvadori
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Shiho Kino
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Vy Thi Nhat Nguyen
- Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Tam Thi-Thanh Nguyen
- Faculty of Odonto-Stomatology, The University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Miho Ishimaru
- The Institute of Education, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | - Dileep De Silva
- Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Belinda Farias Nicolau
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Québec, Canada
| | - Ratilal Lalloo
- The University of Queensland, School of Dentistry, Brisbane, Australia
| | - Roger Junges
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
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Spielvogel I, Gębarowska E, Badora K, Waroszewski J, Budek K, Proćków J, Gałka B, Gębarowski T. Antibacterial and therapeutic potential of historic deposits of silesian healing clay - terra sigillataSilesiaca. JOURNAL OF ETHNOPHARMACOLOGY 2024; 337:118853. [PMID: 39326814 DOI: 10.1016/j.jep.2024.118853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/22/2024] [Accepted: 09/22/2024] [Indexed: 09/28/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The increasing evolution of pathogen resistance is a global problem that requires novel solutions. Recently, an increased interest in ethnomedicinal sources can be observed in the derivation of new medicines. The return to traditional medicinal formulations handed down for generations is being followed, but it is necessary to revise them again, taking into account the generally accepted research protocol. AIM OF THE STUDY We aimed to evaluate the antimicrobial potential of historical deposits of Silesian healing clay (SHC), used in ethnomedicine against Gram-positive bacteria and to assess their biological activity using a primary dermal fibroblast line (NHDF) and a model monocyte line (THP1). MATERIALS AND METHODS Information on medicinal clay deposits that occur in Silesia and are traditionally used in ethnomedicine or ancient medicine and known as terra sigillata Silesiaca or SHC, was selected on available source materials and old prints and maps from the archives of the Polish Geological Institute (Wrocław, Poland). Subsequently, their places of occurrence were identified and traced in the field by taking three deposits from the Silesia territory: Upper Silesia (D1), Opole Silesia (D2), and Lower Silesian (D3) Voivodeships for analysis. Their basic parameters and antimicrobial efficacy against pathogenic bacteria, Gram-positive streptococci and staphylococci, including methicillin-resistant strains, were examined. The study evaluated the effects of clays on growth and vitality using a primary dermal fibroblast line (NHDF) and a monocytic line (THP1). Studies were performed on a cell culture model to determine the effects on tissue regeneration (fibroblasts) and anti-inflammatory effects (monocytes). The study attempted to identify the mechanism of antimicrobial action, especially the textural characteristics and geochemical composition, as well as the environmental reaction (pH). RESULTS SHCs were classified into the following textural classes: clay loam (D1), clay (D2), and sand (D3). The tested deposits have antimicrobial properties that reduce the bacterial population (104 CFU) compared to the control (108 CFU). The antimicrobial effect depends on the type of clay and the species or strain of bacteria used. In-house studies clearly showed that Staphylococcus aureus Pcm 2054 and Staphylococcus epidermidis MRSE ATCC 2538 cells were completely adsorbed by clay minerals from clay D3.13. Furthermore, 10% leachates also showed an antimicrobial effect, as a reduction in bacterial populations was observed ranging from 91 to 100%. The results showed stimulation of fibroblast culture proliferation and inhibition of the growth of inflammatory cells (monocytes). CONCLUSION SHCs tested have antimicrobial potential, in particular D2.7, D2.11, and D3.13. The D3.13 deposit had a bactericidal effect against the staphylococci tested. Aqueous solutions of clays also showed bacteriostatic effect. The results obtained in cell culture model tests indicate properties that modulate the healing process - stimulation of fibroblast growth (NHDF line) and inhibition of monocyte growth (THP1 line).
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Affiliation(s)
- Izabela Spielvogel
- Department of Physiotherapy, Institute of Physiotherapy, Opole University of Technology, Prószkowska 76, 45-758 Opole, Poland.
| | - Elżbieta Gębarowska
- Division of Biogeochemistry and Environmental Microbiology, Department of Plant Protection, Wrocław University of Environmental and Life Sciences, Grunwaldzka 53, 50-357 Wrocław, Poland.
| | - Krzysztof Badora
- Institute of Environmental Engineering and Biotechnology, Opole University, Kominka 4a, 45-052 Opole, Poland.
| | - Jarosław Waroszewski
- Institute of Soil Science, Plant Nutrition and Environmental Protection, Faculty of Life Sciences and Technology, Wrocław University of Environmental and Life Sciences, ul. Grunwaldzka 53, 50-357 Wrocław, Poland.
| | - Karolina Budek
- Division of Biogeochemistry and Environmental Microbiology, Department of Plant Protection, Wrocław University of Environmental and Life Sciences, Grunwaldzka 53, 50-357 Wrocław, Poland.
| | - Jarosław Proćków
- Department of Plant Biology, Institute of Environmental Biology, Wrocław University of Environmental and Life Sciences, Kożuchowska 5b, 51-631 Wrocław, Poland.
| | - Bernard Gałka
- Institute of Soil Science, Plant Nutrition and Environmental Protection, Faculty of Life Sciences and Technology, Wrocław University of Environmental and Life Sciences, ul. Grunwaldzka 53, 50-357 Wrocław, Poland.
| | - Tomasz Gębarowski
- Department of Biostructure and Animal Physiology, Wrocław University of Environmental and Life Sciences, Kożuchowska 1/3, 51-631 Wrocław, Poland.
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Plechatá A, Makransky G, Böhm R. A randomized controlled trial investigating experiential virtual reality communication on prudent antibiotic use. NPJ Digit Med 2024; 7:244. [PMID: 39266716 PMCID: PMC11392957 DOI: 10.1038/s41746-024-01240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 08/24/2024] [Indexed: 09/14/2024] Open
Abstract
Antimicrobial resistance (AMR) is a global health threat. This randomized controlled trial evaluates the impact of experiential virtual reality (VR) versus information provision via VR or leaflet on prudent antibiotic use. A total of 249 (239 analyzed) participants were randomized into three conditions: VR Information + Experience, VR Information, or Leaflet Information. All participants received AMR information, while those in the VR Information + Experience condition additionally engaged in a game, making treatment decisions for their virtual avatar's infection. Participants in the VR Information + Experience condition showed a significant increase in prudent use intentions from baseline (d = 1.48). This increase was significantly larger compared to the VR Information (d = 0.50) and Leaflet Information (d = 0.79) conditions. The increase in intentions from baseline remained significant at follow-up in the VR Information + Experience condition (d = 1.25). Experiential VR communication shows promise for promoting prudent antibiotics use.
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Affiliation(s)
- Adéla Plechatá
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| | - Guido Makransky
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Robert Böhm
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
- Faculty of Psychology, University of Vienna, Vienna, Austria.
- Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark.
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Guo N, Chen J, Kong F, Gao Y, Bian J, Liu T, Hong G, Zhao Z. 5-aminolevulinic acid photodynamic therapy for chronic wound infection in rats with diabetes. Biomed Pharmacother 2024; 178:117132. [PMID: 39047418 DOI: 10.1016/j.biopha.2024.117132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
Recent research indicated that ulcers and peripheral vascular disease resulting from drug-resistant bacterial infections are the main causes of delayed healing in chronic diabetic wounds. 5-Aminolevulinic acid (ALA) is a second-generation endogenous photosensitizer. The therapeutic effect and mechanism of ALA-mediated photodynamic therapy (ALA-PDT) on methicillin-resistant Staphylococcus aureus (MRSA)-infected wounds in diabetic rats were investigated in this study. The results revealed the promising antibacterial effects of ALA-PDT MRSA in vitro, with a minimum inhibitory concentration and minimum bactericidal concentration of 250 and 500 μM, respectively. ALA-PDT also changed the permeability and structural integrity of bacterial cell membranes by producing reactive oxygen species. Meanwhile, ALA-PDT accelerated wound healing in MRSA-infected diabetic rats, with 5 % ALA-PDT achieving complete sterilization in 14 days and wound closure in 21 days. Treatment with 5 % ALA-PDT additionally improved the histopathological appearance of skin tissue, as well as fibrosis, inflammatory cytokine release, and angiogenesis-related protein expression. These findings indicated that ALA-PDT significantly promoted the healing of MRSA-infected wounds in diabetic rats by eliminating bacteria, inhibiting inflammation, generating granulation tissues, promoting neovascularization, and restoring damaged nerves. In addition, the healing mechanism was related to the activation of inflammatory and angiogenesis pathways through the regulation of tumor necrosis factor-alpha and interleukin-6 expression and upregulation of CD206, CD31, and VEGF. These findings underscored the potential role of ALA-PDT in promoting the healing of chronic diabetic wounds.
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Affiliation(s)
- Ning Guo
- School of Basic Medical Sciences, Hebei University, China; Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Jingyu Chen
- Tianjin University of Traditional Chinese Medicine, China.
| | - Feiyan Kong
- School of Basic Medical Sciences, Hebei University, China.
| | | | | | - Tianjun Liu
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Ge Hong
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Zhanjuan Zhao
- School of Basic Medical Sciences, Hebei University, China.
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Wojcik G, Afseth J, Fagan R, Thomson F, Ring N. Patient and public understanding of antimicrobial resistance: a systematic review and meta-ethnography. JAC Antimicrob Resist 2024; 6:dlae117. [PMID: 39114563 PMCID: PMC11303694 DOI: 10.1093/jacamr/dlae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/05/2024] [Indexed: 08/10/2024] Open
Abstract
Objectives To further develop an understanding of laypeople's (adult patients and public) beliefs and attitudes toward antimicrobial resistance (AMR) by developing a conceptual model derived from identifying and synthesizing primary qualitative research. Methods A systematic search of 12 electronic databases, including CINAHL, MEDLINE, PsycINFO, PubMed and Web of Science to identify qualitative primary studies exploring patient and public understanding of AMR published between 2012 and 2022. Included studies were quality appraised and synthesized using Noblit and Hare's meta-ethnographic approach and reported using eMERGe guidance. Results Thirteen papers reporting 12 qualitative studies were synthesized. Studies reported data from 466 participants aged 18-90 years. Five themes were identified from these original studies: the responsible patient; when words become meaningless; patient-prescriber relationship; past experience drives antibiotic use; and reframing public perception. These themes supported the development of a conceptual model that illustrates the tension between two different assumptions, that is, how can antibiotics be used for the collective good whilst balancing the immediate needs of individual patients. Conclusions Findings suggest that AMR is a distinct ethical issue and should not be viewed purely as a prescribing problem. The meta-ethnography-generated conceptual model illustrates many factors affecting the public's perception of AMR. These include laypeople's own knowledge, beliefs and attitudes around antibiotic use, the relationship with the healthcare provider and the wider context, including the overwhelming influence of the media and public health campaigns. Future research is needed to explore effective health messaging strategies to increase laypeople's baseline awareness of AMR as a public threat.
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Affiliation(s)
- Gosha Wojcik
- School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh, EH11 4BN, UK
| | - Janyne Afseth
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, Garthdee House Garthdee Road, Aberdeen, AB10 7QG, UK
| | - Ross Fagan
- School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh, EH11 4BN, UK
| | - Fiona Thomson
- School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh, EH11 4BN, UK
| | - Nicola Ring
- School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh, EH11 4BN, UK
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Miellet S, Byrne MK, Reynolds N, Sweetnam T. A confirmation of the predictive utility of the Antibiotic Use Questionnaire. BMC Public Health 2024; 24:1925. [PMID: 39026260 PMCID: PMC11256407 DOI: 10.1186/s12889-024-18901-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/21/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND The change in the efficacy of antimicrobial agents due to their misuse is implicated in extensive health and mortality related concerns. The Antibiotics Use Questionnaire (AUQ) is a theory driven measure based on the Theory of Planned Behaviour (TpB) factors that is designed to investigate drivers of antibiotic use behaviour. The objective of this study is to replicate the factor structure from the pilot study within a similar Australian confirmation cohort, and to extend this through investigating if the factor structure holds in a Chinese-identifying cohort. METHODS The AUQ was disseminated to two cohorts: a confirmation cohort similar to the original study, and a Chinese identifying cohort. Data analysis was completed on the two data sets independently, and on a combined data set. An orthogonal principal components analysis with varimax rotation was used to assess the factor structure, followed by general linear models to determine the influence of the TpB factors on reported antibiotic use. RESULTS 370 participant responses from the confirmation cohort, and 384 responses from the Chinese-identifying cohort were retained for analysis following review of the data. Results showed modest but acceptable levels of internal reliability across both cohorts. Social norms, and the interaction between attitudes and beliefs and knowledge were significant predictors of self-reported antibiotic use in both cohorts. In the confirmation cohort healthcare training was a significant predictor, and in the Chinese-identifying cohort education was a significant predictor. All other predictors tested produced a nonsignificant relationship with the outcome variable of self-reported antibiotic use. CONCLUSIONS This study successfully replicated the factor structure of the AUQ in a confirmation cohort, as well as a cohort that identified as culturally or legally Chinese, determining that the factor structure is retained when investigated across cultures. The research additionally highlights the need for a measure such as the AUQ, which can identify how differing social, cultural, and community factors can influence what predicts indiscriminate antibiotic use. Future research will be required to determine the full extent to which this tool can be used to guide bespoke community level interventions to assist in the management of antimicrobial resistance.
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Affiliation(s)
- Sebastien Miellet
- School of Psychology, University of Wollongong, Building 41, Northfields Ave, Wollongong, NSW, 2522, Australia.
- Wollongong Antimicrobial Resistance Research Alliance (WARRA), Wollongong, NSW, Australia.
| | - Mitchell K Byrne
- School of Psychology, University of Wollongong, Building 41, Northfields Ave, Wollongong, NSW, 2522, Australia
- Wollongong Antimicrobial Resistance Research Alliance (WARRA), Wollongong, NSW, Australia
| | - Nina Reynolds
- Wollongong Antimicrobial Resistance Research Alliance (WARRA), Wollongong, NSW, Australia
- School of Business, University of Wollongong, Wollongong, NSW, Australia
| | - Taylor Sweetnam
- Faculty of Health, Charles Darwin University, Northern Territory, Australia
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Virhia J, Laurie E, Lembo T, Seni J, Pollack R, Davis A, Mapunjo S, Mshana SE, Mmbaga BT, Hilton S. Developing a logic model for communication-based interventions on antimicrobial resistance (AMR). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002965. [PMID: 38870108 PMCID: PMC11175528 DOI: 10.1371/journal.pgph.0002965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/08/2024] [Indexed: 06/15/2024]
Abstract
The importance of communication in enhancing people's awareness and understanding of antimicrobial resistance (AMR) is consistently recognised in global and national action plans (NAPs). Despite this, there have been relatively few national AMR communication campaigns which use a structured approach to take account of the local context, encompass co-design with the target audience and use a logic model to help inform its design, implementation and evaluation. Designing a logic model for communication-based interventions can help map out the planning, resources, messaging, assumptions and intended outcomes of the campaign to maximise its impact, ensure it is fit for context and minimise any unintended consequences on individuals and society. Building on an AMR research project in Tanzania, Supporting the National Action Plan for AMR (SNAP-AMR), we co-designed the SNAP-AMR Logic Model with key stakeholders to implement AMR communication campaigns and related legacy materials to be employed in support of the Tanzanian NAP, but with broader relevance to a range of contexts. In developing the SNAP-AMR Logic Model, we reviewed relevant communication theories to create and target messages, and we considered behavioural change theories. We defined all key elements of the SNAP-AMR Logic Model as follows: (1) resources (inputs) required to enable the design and implementation of campaigns, e.g. funding, expertise and facilities; (2) activities, e.g. co-design of workshops (to define audience, content, messages and means of delivery), developing and testing of materials and data collection for evaluation purposes; (3) immediate deliverables (outputs) such as the production of legacy materials and toolkits; and (4) changes (outcomes) the campaigns aim to deliver, e.g. in social cognition and behaviours. The SNAP-AMR Logic Model efficiently captures all the elements required to design, deliver and evaluate AMR communication-based interventions, hence providing government and advocacy stakeholders with a valuable tool to implement their own campaigns. The model has potential to be rolled out to other countries with similar AMR socio-cultural, epidemiological and economic contexts.
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Affiliation(s)
- Jennika Virhia
- MRC/CSO School of Social & Public Health Sciences Unit/School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Emma Laurie
- School of Geographical and Earth Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Tiziana Lembo
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill-Bugando School of Medicine, Catholic University of Health and Allied Sciences, Bugando Medical Centre, Mwanza, Tanzania
| | - Roxana Pollack
- MRC/CSO School of Social & Public Health Sciences Unit/School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Alicia Davis
- School of Social and Political Sciences/School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Siana Mapunjo
- National Institute for Medical Research and Ministry of Health, Dodoma, Tanzania
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill-Bugando School of Medicine, Catholic University of Health and Allied Sciences, Bugando Medical Centre, Mwanza, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Shona Hilton
- MRC/CSO School of Social & Public Health Sciences Unit/School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Turner JP, Newport K, McEvoy AM, Smith T, Tannenbaum C, Kelly DV. Strategies to guide the successful implementation of deprescribing in community practice: Lessons learned from the front line. Can Pharm J (Ott) 2024; 157:133-142. [PMID: 38737354 PMCID: PMC11086729 DOI: 10.1177/17151635241240737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 05/14/2024]
Abstract
Background Sustainable implementation of new professional services into clinical practice can be difficult. In 2019, a population-wide initiative called SaferMedsNL was implemented across the province of Newfoundland and Labrador (NL), to promote appropriate medication use. Two evidence-based interventions were adapted to the context of NL to promote deprescribing of proton pump inhibitors and sedatives. The objective of this study was to identify and prioritize which actions supported the implementation of deprescribing in community practice for pharmacists, physicians and nurse practitioners across the province. Methods Community pharmacists, physicians and nurse practitioners were invited to participate in virtual focus groups. Nominal Group Technique was used to elicit responses to the question: "What actions support the implementation of deprescribing into the daily workflow of your practice?" Participants prioritized actions within each group while thematic analysis permitted comparison across groups. Results Five focus groups were held in fall 2020 involving pharmacists (n = 11), physicians (n = 7) and nurse practitioners (n = 4). Participants worked in rural (n = 10) and urban (n = 12) settings. The different groups agreed on what the top 5 actions were, with the top 5 receiving 68% of the scores: (1) providing patient education, (2) allocating time and resources, (3) building interprofessional collaboration and communication, (4) fostering patient relationships and (5) aligning with public awareness strategies. Conclusion Pharmacists, physicians and nurse practitioners identified similar actions that supported implementing evidence-based deprescribing into routine clinical practice. Sharing these strategies may help others embed deprescribing into daily practice and assist the uptake of medication appropriateness initiatives by front-line providers. Can Pharm J (Ott) 2024;157:xx-xx.
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Affiliation(s)
- Justin P. Turner
- Centre for Medicines Use and Safety, Memorial University of Newfoundland, Newfoundland and Labrador
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia; the Faculty of Pharmacy, Memorial University of Newfoundland, Newfoundland and Labrador
- Université de Montréal, Québec; the Centre de recherche, Institut universitaire de gériatrie de Montréal, Memorial University of Newfoundland, Newfoundland and Labrador
- Québec; the Faculté de Pharmacie, Memorial University of Newfoundland, Newfoundland and Labrador
| | - Kelda Newport
- Laval Université, Québec; and the School of Pharmacy, Memorial University of Newfoundland, Newfoundland and Labrador
| | - Aisling M. McEvoy
- Centre for Medicines Use and Safety, Memorial University of Newfoundland, Newfoundland and Labrador
| | - Tara Smith
- Laval Université, Québec; and the School of Pharmacy, Memorial University of Newfoundland, Newfoundland and Labrador
| | - Cara Tannenbaum
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia; the Faculty of Pharmacy and Medicine, Memorial University of Newfoundland, Newfoundland and Labrador
- Université de Montréal, Québec; the Centre de recherche, Institut universitaire de gériatrie de Montréal, Memorial University of Newfoundland, Newfoundland and Labrador
| | - Deborah V. Kelly
- Laval Université, Québec; and the School of Pharmacy, Memorial University of Newfoundland, Newfoundland and Labrador
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Charbonneau M, Morgan SG, Gagnon C, Sadowski CA, Silvius JL, Tannenbaum C, Turner JP. Factors influencing the effects of policies and interventions to promote the appropriate use of medicines in high-income countries: A rapid realist review. Health Policy 2024; 142:105027. [PMID: 38452575 DOI: 10.1016/j.healthpol.2024.105027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 11/28/2023] [Accepted: 02/17/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The appropriate use of medicines has long been recognized as a fundamental component of medicine policies. We aimed to extract lessons from published research on how policy contexts and mechanisms can affect the outcomes of national- or health-system level interventions to promote appropriate medicine use (defined as an increase in underutilized medications or decrease in inappropriate medication use). METHODS We conducted a rapid realist review of published evidence concerning system-level policies to promote the appropriate use of medicines in high-income countries with universal prescription drug coverage. We searched MEDLINE and Embase to identify relevant publications. We used a realist evaluation framework to identify contexts, mechanisms, and outcomes for each intervention and to hypothesize which policy contexts and mechanisms supported successful outcomes in terms of relative changes in the prevalence of use of the specific medication classes targeted. RESULTS From 1,318 identified studies, 18 met our inclusion criteria. 13 distinct policies were identified. Three main policy-related factors underpinned successful interventions: involving providers and patients through program interventions; central coordination through national agencies dedicated to medicine policies; and the establishment of an explicit and integrated national medicine policy strategy. CONCLUSION Policymakers can improve coordination of national pharmaceutical policies to reduce harms from inappropriate medicines use, thus improving health outcomes through cost-effective programs.
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Affiliation(s)
- Mathieu Charbonneau
- Canadian Medication Appropriateness and Deprescribing Network, Montreal, Université de Montréal, QC, Canada.
| | - Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver BC, Canada
| | - Camille Gagnon
- Canadian Medication Appropriateness and Deprescribing Network, Université de Montréal, Montreal, QC, Canada
| | - Cheryl A Sadowski
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - James L Silvius
- Alberta Health Services, Edmonton, AB, Canada; Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cara Tannenbaum
- Faculties of Pharmacy and Medicine, Université de Montréal, Montreal, QC, Canada; Michel Saucier Endowed Chair in Pharmacy, Health & Aging, Université de Montréal, Montreal, QC, Canada
| | - Justin P Turner
- Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
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10
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Kong W, Zhang X, Li M, Yang H. Microbiological analysis and antibiotic selection strategy in neck abscesses among patients with diabetes mellitus. Eur Arch Otorhinolaryngol 2024; 281:1515-1523. [PMID: 38145982 DOI: 10.1007/s00405-023-08396-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE This study aimed to analyze the clinical characteristics, pathogen distribution, drug sensitivity, and antibiotic treatment strategies of patients with neck abscesses with or without diabetes. METHODS A retrospective analysis was conducted on 2194 patients who underwent neck abscess surgery at our hospital over the past 13 years. Patients were grouped as NAwithDM (neck abscess with diabetes mellitus) or NAwithoutDM (neck abscess without diabetes mellitus). Clinical features, pathogen distribution, and antibiotic sensitivity were compared between the groups. Venn diagrams were used to illustrate the antibiotics effective against all three predominant pathogens. RESULTS A total of 2194 patients with neck abscesses were included in this study, with 579 patients (26.43%) in the NAwithDM group and 1612 patients (73.51%) in the NAwithoutDM group. There were no significant differences in sex or age distribution between the two groups (all P > 0.05). However, there were significant differences in BMI, length of hospital stays, occurrence of laryngeal obstruction, hypertension, and hypoalbuminemia between the two groups (all P < 0.05). In the NAwithoutDM group, the top three pathogens were Streptococcus constellatus, Klebsiella pneumoniae, and Staphylococcus aureus. The antibiotics that were simultaneously effective against all three pathogens were ceftriaxone, moxifloxacin, and ampicillin/sulbactam. In the NAwithDM group, the top three pathogens were Streptococcus pyogenes, Streptococcus pneumoniae, and Streptococcus constellatus. The antibiotics that were simultaneously effective against all three pathogens were compound sulfamethoxazole, cefuroxime, levofloxacin, ciprofloxacin, vancomycin, and imipenem. CONCLUSION Neck abscess patients with diabetes have distinct clinical features. Therefore, it is crucial to pay attention to these clinical features and manage them accordingly during the treatment process. Empirical antibiotic treatment should be tailored to individual patient groups. Sulfamethoxazole-methoxazole is recommended for neck abscess patients with diabetes, while ceftriaxone or moxifloxacin is recommended for those without diabetes.
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Affiliation(s)
- Weili Kong
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyun Zhang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Li
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Yang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China.
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11
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Slekovec C, Lepiller Q, Anxionnat R, Mouillet S, Ferreira D, Guillaume A, Kubicki A, Le Bourvellec L, Maitre D, Meurisse A, August MJ, Bertrand X, Moulin T, Bouiller K, Nerich V. French healthcare students and antibiotics: are they ready to promote their appropriate use? JAC Antimicrob Resist 2024; 6:dlad147. [PMID: 38161961 PMCID: PMC10757466 DOI: 10.1093/jacamr/dlad147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives French healthcare students are required to carry out primary prevention interventions as part of the Healthcare Service by Healthcare Students (HSHS). The purpose of this study was to explore students' perceptions of preparedness to address the public's concerns about antibiotic use and how their perceptions changed after implementing their intervention. Methods A questionnaire was sent twice during the 2020-2021 academic year to 920 multidisciplinary healthcare students (nursing, medicine, physiotherapy, pharmacy and midwifery students) enrolled in the HSHS in Franche-Comté (HSHS-FC). Results This study included 870/920 students (94.6%). Medical and pharmacy students were the most concerned about the issue of antimicrobial resistance. Before enrollment in the HSHS-FC, 463 of the 870 students included (53.2%) reported having sufficient knowledge about antibiotics to lead preventive interventions, reaching 87.9% (58/66) for pharmacy students. Despite this relative lack of knowledge, 77.2% of students felt confident to promote the appropriate use of antibiotics in the healthcare service context. This rate ranged from 68.0% (17/25) for midwifery students to 93.9% (62/66) for pharmacy students. Irrespective of the topic of the intervention, students significantly improved their knowledge and ability to promote antibiotic use after training in the HSHS-FC. Conclusions Theoretical prerequisites and a feeling of concern vary widely depending on the curriculum. The HSHS-FC promotes multidisciplinary collaboration and can contribute to improving students' knowledge. The support of an expert in antimicrobial resistance may be necessary to validate the content of the interventions proposed by the students.
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Affiliation(s)
- Céline Slekovec
- Université de Franche-Comté, UFR Santé-départment de pharmacie, F-25000 Besançon, France
- Centre d’Appui pour la Prévention des Infections Associées aux Soins de Bourgogne-Franche-Comté, Centre Hospitalier Universitaire de Besançon, F-25000 Besançon, France
- Université de Franche-Comté, UMR-CNRS 6249 Chrono-environnement, 19 rue Ambroise Paré, F-25000 Besançon, France
| | - Quentin Lepiller
- Université de Franche-Comté, UFR Santé-départment de pharmacie, F-25000 Besançon, France
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Besançon, F-25000 Besançon, France
- Université de Franche-Comté, laboratoire EA3181, F-25000 Besançon, France
| | - Raphaël Anxionnat
- Service de Pédiatrie, Centre Hospitalier Universitaire de Besançon, F-25000 Besançon, France
| | - Sophie Mouillet
- Institut de Formation en Soins Infirmiers, F-25000 Besançon, France
| | - David Ferreira
- Université de Franche-Comté, UFR Santé-départment de pharmacie, F-25000 Besançon, France
- Service d’Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Universitaire de Besançon, F-25000 Besançon, France
| | - Agnès Guillaume
- Unité de Formation en Masso-Kinésithérapie, Centre Hospitalier Universitaire de Besançon, F-25000 Besançon, France
| | - Alexandre Kubicki
- Université de Franche-Comté, Département des Sciences de la Rééducation, UFR Santé, F-25200 Montbéliard, France
- Université de Franche-Comté, UR LINC, F-25200 Montbéliard, France
| | | | - Doriane Maitre
- Institut de Formation en Soins Infirmiers, Lons-le-Saunier, France
| | - Aurélia Meurisse
- Unité de Méthodologie et Qualité de Vie en Cancérologie, Centre Hospitalier Universitaire de Besançon, F-25000 Besançon, France
| | - Miguel Joseph August
- Instance Régionale d’Éducation et de Promotion de la Santé de Bourgogne-Franche-Comté, F-25000 Besançon, France
| | - Xavier Bertrand
- Université de Franche-Comté, UFR Santé-départment de pharmacie, F-25000 Besançon, France
- Université de Franche-Comté, UMR-CNRS 6249 Chrono-environnement, 19 rue Ambroise Paré, F-25000 Besançon, France
- Service d’Hygiène Hospitalière, CHU Besançon, F-25000 Besançon, France
| | - Thierry Moulin
- Université de Franche-Comté, UFR Santé-départment de pharmacie, F-25000 Besançon, France
- Service de Neurologie, CHU Besançon, F-25000 Besançon, France
| | - Kevin Bouiller
- Université de Franche-Comté, UFR Santé-départment de pharmacie, F-25000 Besançon, France
- Université de Franche-Comté, UMR-CNRS 6249 Chrono-environnement, 19 rue Ambroise Paré, F-25000 Besançon, France
- CHU Besançon, Service de Maladies Infectieuses, F-25000 Besançon, France
| | - Virginie Nerich
- Université de Franche-Comté, UFR Santé-départment de pharmacie, F-25000 Besançon, France
- Department of Pharmacy, CHU Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Université de Franche-Comté, F-25000 Besançon, France
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12
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Singh-Phulgenda S, Antoniou P, Wong DLF, Iwamoto K, Kandelaki K. Knowledge, attitudes and behaviors on antimicrobial resistance among general public across 14 member states in the WHO European region: results from a cross-sectional survey. Front Public Health 2023; 11:1274818. [PMID: 38074764 PMCID: PMC10704021 DOI: 10.3389/fpubh.2023.1274818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023] Open
Abstract
Background Antimicrobial resistance (AMR) is a major global public health threat requiring urgent action. Pan-European data on knowledge, attitudes and behaviors among the general public regarding antibiotic use and AMR is limited. Methods A multicentric, cross-sectional survey of the general public was conducted in the capital cities of 14 Member States of the WHO European Region. A validated questionnaire from the AMR Eurobarometer survey was used to collect data on antibiotic use and knowledge, access to antibiotics, and understanding of policy responses through face-to-face exit interviews. Results Out of 8,221 respondents from 14 Member States, 50% took antibiotics in the past 12 months and the majority (53%) obtained their most recent course from a medical practitioner. The most reported reasons for taking antibiotics orally in the past 12 months were cold (24%), sore throat (21%), cough (18%), and flu (16%). Overall, 84% of participants showed a lack of knowledge about appropriate antibiotic use. However, only 37% of respondents reported receiving any information in the past year about the importance of avoiding unnecessary antibiotic use. Doctors were the most cited (50%) and most trusted (80%) source of information. Among respondents who experienced COVID-19, 28% took antibiotics with a prescription, while 8% took antibiotics without a prescription. Conclusion This study highlights the urgent need for targeted awareness campaigns and educational initiatives to address knowledge gaps and promote responsible antibiotic use. The findings emphasize the role of the general population in combating AMR. The data serve as baseline information for future evaluations and interventions in the Region.
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Affiliation(s)
- Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, United Kingdom
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13
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Smith E, Buchan S. Skewed perception of personal behaviour as a contributor to antibiotic resistance and underestimation of the risks. PLoS One 2023; 18:e0293186. [PMID: 37917754 PMCID: PMC10621963 DOI: 10.1371/journal.pone.0293186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023] Open
Abstract
The increasing prevalence of antibiotic-resistant bacteria poses a significant threat to global human health. Countering this threat requires the public to understand the causes of, and risks posed by, antibiotic resistance (AR) to support changing healthcare and societal approaches to antibiotic use. To gauge public knowledge, we designed a questionnaire to assess awareness of causes of AR (both personal and societal) and knowledge of absolute and relative risks posed by antibiotic-resistant bacteria. Our findings reveal that while >90% respondents recognized personal behaviours as limiting AR, few individuals recognized the importance of societal factors e.g. the use of antibiotics in livestock. Furthermore, more respondents named viruses (either by name or as a group) than bacteria as reasons to take antibiotics, indicating lack of understanding. The absolute numbers of current and predicted future deaths attributed to antibiotic-resistant bacteria were under-estimated and respondents were more concerned about climate change and cancer than AR across all age groups and educational backgrounds. Our data reveal that despite heightened public awareness of infection-control measures following the COVID-19 pandemic, there remains a knowledge gap related to contributors and impacts of increasing numbers of antibiotic-resistant bacteria.
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Affiliation(s)
- Emily Smith
- Department of Life and Environmental Science, Bournemouth University, Poole, United Kingdom
| | - Sarah Buchan
- Department of Life and Environmental Science, Bournemouth University, Poole, United Kingdom
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14
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Alejandro AL, Leo WWC, Bruce M, Gimutao K. Does antibiotic awareness campaigns exposure decrease intention to demand antibiotic treatment? Testing a structural model among parents in Western Australia. PLoS One 2023; 18:e0285396. [PMID: 37200317 PMCID: PMC10194918 DOI: 10.1371/journal.pone.0285396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/22/2023] [Indexed: 05/20/2023] Open
Abstract
Antimicrobial resistance (AMR) is one of the key public health concerns the world is facing today. The effect of antibiotic awareness campaigns (AACs) on consumer behaviour has been documented in the literature with mixed results. Understanding the mechanism for how AACs affect target populations is vital in designing effective and tailored campaigns. Using structural equation modelling our study examined the relationships among people's exposure to antibiotic awareness campaigns, knowledge of AMR prevention, AMR risk perception, and intention to seek antibiotic treatment. This study also tested the moderating effect of anxiety and societal responsibility on preventing AMR, and on their intention to demand antibiotic treatment mediated by knowledge of AMR prevention and risk-perception. Primary data was generated using an online survey of 250 Western Australian parents. We tested our hypotheses using reliability and validity tests and structural equation modelling. Our results show that exposure to AACs alone may not be enough to change parental intention to demand antibiotic prescription for their children. Parental risk perception of AMR and parental anxiety affect intention to demand antibiotics, and the view that AMR is a social responsibility has a moderating effect on intention to demand antibiotics. These factors could be considered and combine messaging strategies in designing future antibiotic awareness campaigns.
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Affiliation(s)
- Aaron Lapuz Alejandro
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Murdoch, Australia
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
- Fiona Stanley Hospital, Murdoch, Australia
| | | | - Mieghan Bruce
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Murdoch, Australia
- School of Veterinary Medicine, Murdoch University, Murdoch, Australia
| | - Kaymart Gimutao
- Developmental Communication, University of the Philippines, Los Baños, Philippines
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15
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McCracken CM, Tucker KJ, Tallman GB, Holmer HK, Noble BN, McGregor JC. General Perceptions and Knowledge of Antibiotic Resistance and Antibiotic Use Behavior: A Cross-Sectional Survey of US Adults. Antibiotics (Basel) 2023; 12:antibiotics12040672. [PMID: 37107034 PMCID: PMC10135168 DOI: 10.3390/antibiotics12040672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 04/03/2023] Open
Abstract
This study aimed to assess understanding of antibiotic resistance and evaluate antibiotic use themes among the general public. In March 2018, respondents that were ≥21 years old and residing in the United States were recruited from ResearchMatch.org and surveyed to collect data on respondent expectations, knowledge, and opinions regarding prescribing antibiotics and antibiotic resistance. Content analysis was used to code open-ended definitions of antibiotic resistance into central themes. Chi-square tests were used to assess differences between the definitions of antibiotic resistance and antibiotic use. Among the 657 respondents, nearly all (99%) had taken an antibiotic previously. When asked to define antibiotic resistance, the definitions provided were inductively coded into six central themes: 35% bacteria adaptation, 22% misuse/overuse, 22% resistant bacteria, 10% antibiotic ineffectiveness, 7% body immunity, and 3% provided an incorrect definition with no consistent theme. Themes that were identified in respondent definitions of resistance significantly differed between those who reported having shared an antibiotic versus those who had not (p = 0.03). Public health campaigns remain a central component in the fight to combat antibiotic resistance. Future campaigns should address the public’s understanding of antibiotic resistance and modifiable behaviors that may contribute to resistance.
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Affiliation(s)
- Caitlin M. McCracken
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, OR 97331, USA
| | - Kendall J. Tucker
- Department of Pharmacy Practice, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA 18766, USA
- Correspondence:
| | | | - Haley K. Holmer
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR 97201, USA
| | - Brie N. Noble
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, OR 97331, USA
| | - Jessina C. McGregor
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, OR 97331, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR 97201, USA
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16
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Primeau CA, McWhirter JE, Carson C, McEwen SA, Parmley EJ. Exploring medical and veterinary student perceptions and communication preferences related to antimicrobial resistance in Ontario, Canada using qualitative methods. BMC Public Health 2023; 23:483. [PMID: 36915074 PMCID: PMC10012462 DOI: 10.1186/s12889-023-15193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 02/02/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) threatens our ability to treat and prevent infectious diseases worldwide. A significant driver of AMR is antimicrobial use (AMU) in human and veterinary medicine. Therefore, education and awareness of AMR among antimicrobial prescribers is critical. Human and animal health professionals play important roles in the AMR issue, both as contributors to the emergence of AMR, and as potential developers and implementers of effective solutions. Studies have shown that engaging stakeholders prior to developing communication materials can increase relevance, awareness, and dissemination of research findings and communication materials. As future antimicrobial prescribers, medical and veterinary students' perspectives on AMR, as well as their preferences for future communication materials, are important. The first objective of this study was to explore medical and veterinary student perceptions and understanding of factors associated with emergence and spread of AMR. The second objective was to identify key messages, knowledge translation and transfer (KTT) methods, and dissemination strategies for communication of AMR information to these groups. METHODS Beginning in November 2018, focus groups were conducted with medical and veterinary students in Ontario, Canada. A semi-structured format, using standardized open-ended questions and follow-up probing questions was followed. Thematic analysis was used to identify and analyze patterns within the data. RESULTS Analyses showed that students believed AMR to be an important global issue and identified AMU in food-producing animals and human medicine as the main drivers of AMR. Students also highlighted the need to address society's reliance on antimicrobials and the importance of collaboration between different sectors to effectively reduce the emergence and transmission of AMR. When assessing different communication materials, students felt that although infographics provide easily digestible information, other KTT materials such as fact sheets are better at providing more information without overwhelming the target audiences (e.g., professional or general public). CONCLUSION Overall, the study participants felt that AMR is an important issue and emphasized the need to develop different KTT tools for different audiences. This research will help inform the development of future communication materials, and support development of AMR-KTT tools tailored to the needs of different student and professional groups.
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Affiliation(s)
- Courtney A Primeau
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, N1G 2W1, Guelph, ON, Canada. .,Centre for Food-borne, Environmental and Zoonotic Infectious Disease, Public Health Agency of Canada, N1H 7M7, Guelph, ON, Canada.
| | - Jennifer E McWhirter
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, N1G 2W1, Guelph, ON, Canada
| | - Carolee Carson
- Centre for Food-borne, Environmental and Zoonotic Infectious Disease, Public Health Agency of Canada, N1H 7M7, Guelph, ON, Canada
| | - Scott A McEwen
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, N1G 2W1, Guelph, ON, Canada
| | - E Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, N1G 2W1, Guelph, ON, Canada
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Magnano San Lio R, Favara G, Maugeri A, Barchitta M, Agodi A. How Antimicrobial Resistance Is Linked to Climate Change: An Overview of Two Intertwined Global Challenges. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1681. [PMID: 36767043 PMCID: PMC9914631 DOI: 10.3390/ijerph20031681] [Citation(s) in RCA: 192] [Impact Index Per Article: 192.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 05/13/2023]
Abstract
Globally, antimicrobial resistance (AMR) and climate change (CC) are two of the top health emergencies, and can be considered as two interlinked public health priorities. The complex commonalities between AMR and CC should be deeply investigated in a One Health perspective. Here, we provided an overview of the current knowledge about the relationship between AMR and CC. Overall, the studies included pointed out the need for applying a systemic approach to planetary health. Firstly, CC increasingly brings humans and animals into contact, leading to outbreaks of zoonotic and vector-borne diseases with pandemic potential. Although it is well-established that antimicrobial use in human, animal and environmental sectors is one of the main drivers of AMR, the COVID-19 pandemic is exacerbating the current scenario, by influencing the use of antibiotics, personal protective equipment, and biocides. This also results in higher concentrations of contaminants (e.g., microplastics) in natural water bodies, which cannot be completely removed from wastewater treatment plants, and which could sustain the AMR spread. Our overview underlined the lack of studies on the direct relationship between AMR and CC, and encouraged further research to investigate the multiple aspects involved, and its effect on human health.
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Affiliation(s)
| | | | | | | | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy
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18
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Hou J, Long X, Wang X, Li L, Mao D, Luo Y, Ren H. Global trend of antimicrobial resistance in common bacterial pathogens in response to antibiotic consumption. JOURNAL OF HAZARDOUS MATERIALS 2023; 442:130042. [PMID: 36182890 DOI: 10.1016/j.jhazmat.2022.130042] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
The emergence of antimicrobial resistance (AMR) is a growing public health threat worldwide and antibiotic consumption is being increasingly recognized as the main selective pressure driving this resistance. However, global trend in antibiotic resistance in response to antibiotic consumption is not fully understood. In this study, we collected national resistance data on specific resistant pathogens considered by the World Health Organization (WHO) as priority and antibiotic consumption data for 61 countries to assess the global trends in antibiotic resistance of those common bacterial pathogens and their association with antibiotic consumption. The low- and middle-income countries (LMICs) represented the largest hotspots of resistance, which presented relatively higher resistance rates in common bacterial pathogens but lower antibiotic consumption rates compared to high-income countries (HICs). Specifically, we developed the Normalized Antibiotic Resistance/Consumption Index (NARCI) and produced global maps of NARCI to roughly assess the appropriateness of antibiotic consumption across countries and to indicate the potentially inappropriate antibiotic consumption in LMICs compared with HICs. Additionally, we linked antibiotic consumption rates and resistance rates of target pathogens, in conjunction with NARCI and the correlation analysis between antibiotic use and resistance, to inform strategies to alleviate the threat of antibiotic resistance worldwide.
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Affiliation(s)
- Jie Hou
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Xiang Long
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Xiaolong Wang
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Linyun Li
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Daqing Mao
- School of Medicine, Nankai University, Tianjin 300071, China.
| | - Yi Luo
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China; State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210093, China.
| | - Hongqiang Ren
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210093, China
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Calvo-Villamañán A, San Millán Á, Carrilero L. Tackling AMR from a multidisciplinary perspective: a primer from education and psychology. Int Microbiol 2023; 26:1-9. [PMID: 36224500 PMCID: PMC9556281 DOI: 10.1007/s10123-022-00278-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 01/06/2023]
Abstract
Antimicrobial resistance (AMR) is currently one of the most concerning threats in public health. The efforts to tackle the problem require a global One Health approach, using multidisciplinary approaches and a thorough understanding of the topic both by the general public and the experts. Currently, the lack of a shared mental model of the problem, the absence of a sense of responsibility amongst the different actors and a deficient education on the topic burden the efforts to slow down the emergency and spread of antimicrobial resistant infections. We here propose a multidisciplinary approach to tackle the AMR problem, taking into consideration not only the input from the biological and medical sciences but also the input from the social sciences. Specifically, we suggest strategies from education and psychology to increase awareness about antimicrobial resistance and to implement more effective interventions. Finally, we advocate for a comprehensive and a solidaristic model as the only solution for a problem which knows no borders. As such, political will and international cooperation will be key to achieve the desired change in antibiotic resistance trend.
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Affiliation(s)
- Alicia Calvo-Villamañán
- grid.428469.50000 0004 1794 1018Department of Microbial Biotechnology, Centro Nacional de Biotecnología–CSIC, 28049 Madrid, Spain
| | - Álvaro San Millán
- grid.428469.50000 0004 1794 1018Department of Microbial Biotechnology, Centro Nacional de Biotecnología–CSIC, 28049 Madrid, Spain
| | - Laura Carrilero
- grid.11835.3e0000 0004 1936 9262School of Biosciences, The University of Sheffield, Western Bank, Sheffield, S10 2TN UK
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Shamim MA, Padhi BK, Satapathy P, Siddiq A, Manna S, Aggarwal AK, Al-Ahdal T, Khubchandani J, Henao-Martinez AF, Sah R. Parents' expectation of antibiotic prescriptions for respiratory infections in children: a systematic review and meta-analysis. Ther Adv Infect Dis 2023; 10:20499361231169429. [PMID: 37206057 PMCID: PMC10189844 DOI: 10.1177/20499361231169429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/27/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives Despite most childhood infections being self-limiting, children are among the leading consumers of antibiotics. Little is known about parental expectations of antibiotics for childhood infections. A comprehensive systematic review and meta-analysis was conducted to explore the nature and extent of parental expectations of antibiotic prescriptions for children with respiratory infections. Design Systematic review and meta-analysis. Methods An extensive literature search using six major scientific databases was conducted for all published articles until 7 December 2022. Primary studies reporting parents' expectations of antibiotics for children with upper respiratory tract infections were included after assessment for quality. Heterogeneity between the studies was assessed using the I2 statistic and publication bias was analyzed using funnel plots and Egger regression tests. The primary outcome was a summary estimate of the percentage of parents who expect antibiotics from their physicians when their child presents with an upper respiratory tract infection. Results From a total of 4510 studies found in the initial searches, a final pool of 19 eligible studies with 15,664 individuals was included in this meta-analysis. Nine of the 19 studies were from the United States or Saudi Arabia. The pooled prevalence of parental expectations of antibiotics in the population reviewed was 55.78% (95% CI = 44.60-66.41). There was significant heterogeneity between the studies, but funnel plot and meta-regression did not detect any publication bias. Conclusion More than half of parents expect antibiotics for their children during consultation for upper respiratory tract infections. Such practices may cause undue side effects among children, contribute to the growing burden of antibiotic resistance, and lead to treatment failure for many common infections in the future. To optimize efforts to tackle antimicrobial resistance, shared decision-making and education emphasizing the proper and judicious use of antibiotics are much needed in pediatric healthcare settings. This can also help to manage parents' expectations when seeking antibiotics for their children. Despite pressure from parents, pediatric healthcare providers should continue to advocate for antibiotic use only when warranted and help improve knowledge and awareness amongst parents. Registration The protocol has been registered with PROSPERO (CRD42022364198).
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Affiliation(s)
| | | | - Prakasini Satapathy
- Department of Virology, Postgraduate Institute
of Medical Education and Research, Chandigarh, India
| | | | | | - Arun K. Aggarwal
- Department of Community Medicine and School of
Public Health, Postgraduate Institute of Medical Education and Research,
Chandigarh, India
| | - Tareq Al-Ahdal
- Institute of Global Health, Heidelberg
University, Heidelberg, Germany
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21
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Simegn W, Moges G. Awareness and knowledge of antimicrobial resistance and factors associated with knowledge among adults in Dessie City, Northeast Ethiopia: Community-based cross-sectional study. PLoS One 2022; 17:e0279342. [PMID: 36584014 PMCID: PMC9803210 DOI: 10.1371/journal.pone.0279342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/04/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is an important global health challenge. The current study aimed to assess the level of awareness and knowledge of antimicrobial resistance and factors associated with knowledge among adults in Dessie City, Ethiopia. METHODS A community-based cross-sectional study was conducted among 407 adults in Dessie City from June to July 2021. A systematic random sampling technique was used to select respondents, and Google Form was used to collect data online. The data was analyzed by SPSS Version 26. The associated factors of knowledge of antimicrobial resistance were identified by using bivariate and multivariable logistic regression. Independent variables with a P-value <0.2 were selected as candidate variables for multivariable logistic regression. Those variables with a P-value <0.05 were declared statistically significant factors. RESULT Out of the required sample sizes, four hundred and seven participants were enrolled, giving a response rate of 99.3%. One hundred and fifty-two (37.3%) respondents were females. Nearly one-third of the respondents (28.3%) have taken antibiotics in the last 6 months. In this study, 73.7% of study participants were aware of the existence of germs; 58.2% were aware of the existence of antibiotic resistance to bacteria; 47.7% were aware of the existence of drug resistance; 39.8% were aware of the existence of antimicrobial resistance; and 36.6% were aware of the existence of antibiotic resistance. Sixty-four (15.7%) respondents were not aware of any of the above terms. Sixty (14.7%) of the respondents were not aware of any risk factor for antimicrobial resistance. About 63 (15.5%) of the respondents did not know the consequences of antimicrobial resistance. Two hundred and thirty-eight (58.5%) respondents had good knowledge of antimicrobial resistance. In this study, being male (AOR = 1.99; 95% CI: 1.23,3.20), college and above educational level (AOR = 3.50; 95% CI: 1.08,11.39), grade 11-12 educational level (AOR = 3.73; 95% CI: 1.20,11.61), getting advice from health professionals about how to take antibiotics (AOR = 1.84; 95% CI:1.07,3.17), using health professionals as a source of information on antibiotics (AOR = 2.51; 95% CI: 1.48,4.25), and taking antibiotics without prescription (AOR = 1.86; 95% CI: 1.04,3.30) were significantly associated with good knowledge of antimicrobial resistance. CONCLUSION The study identified low awareness and knowledge of antimicrobial resistance among adults. Being male, higher educational level, getting advice from health professionals about how to take antibiotics, using health professionals as a source of information on antibiotics, and taking antibiotics without a prescription were significantly associated with good knowledge of antimicrobial resistance. Educational campaigns would be highly desirable for the public to improve their awareness and knowledge of antimicrobial resistance.
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Affiliation(s)
- Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Getachew Moges
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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22
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Suttels V, Van Singer M, Clack LC, Plüss-Suard C, Niquille A, Mueller Y, Boillat Blanco N. Factors Influencing the Implementation of Antimicrobial Stewardship in Primary Care: A Narrative Review. Antibiotics (Basel) 2022; 12:30. [PMID: 36671230 PMCID: PMC9854946 DOI: 10.3390/antibiotics12010030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is directly driven by inappropriate use of antibiotics. Although the majority of antibiotics (an estimated 80%) are consumed in primary care settings, antimicrobial stewardship (AMS) activities in primary care remain underdeveloped and factors influencing their implementation are poorly understood. This can result in promising stewardship activities having little-to-no real-world impact. With this narrative review, we aim to identify and summarize peer-reviewed literature reporting on (1) the nature and impact of AMS interventions in primary care and (2) the individual and contextual factors influencing their implementation. Reported activities included AMS at different contextual levels (individual, collective and policy). AMS activities being often combined, it is difficult to evaluate them as stand-alone interventions. While some important individual and contextual factors were reported (difficulty to reach physicians leading to a low uptake of interventions, tight workflow of physicians requiring implementation of flexible and brief interventions and AMS as a unique opportunity to strengthen physician-patients relationship), this review identified a paucity of information in the literature about the factors that support or hinder implementation of AMS in primary care settings. In conclusion, identifying multilevel barriers and facilitators for AMS uptake is an essential step to explore before implementing primary care AMS interventions.
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Affiliation(s)
- Véronique Suttels
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Mathias Van Singer
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Lauren Catherine Clack
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, 8006 Zürich, Switzerland
| | - Catherine Plüss-Suard
- Swiss Centre for Antibiotic Resistance, Institute for Infectious Diseases, University of Bern, 3001 Bern, Switzerland
| | - Anne Niquille
- Center for Primary Care and Public Health (Unisanté), Pharmacy University of Lausanne, 1011 Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, 1011 Lausanne, Switzerland
| | - Yolanda Mueller
- Center for Primary Care and Public Health (Unisanté), Department of Family Medicine, 1011 Lausanne, Switzerland
| | - Noémie Boillat Blanco
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
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23
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Effects of social norm feedback on antibiotic prescribing and its characteristics in behaviour change techniques: a mixed-methods systematic review. THE LANCET INFECTIOUS DISEASES 2022; 23:e175-e184. [PMID: 36521504 DOI: 10.1016/s1473-3099(22)00720-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/28/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
Low-cost and low-barrier antibiotic stewardship strategies are urgently needed to deal with the widespread problem of antibiotic resistance. Social norm feedback could be a promising strategy. In this mixed-methods systematic review (PROSPERO: CRD42022361039), we aimed to identify the key behaviour change techniques used in social norm feedback for antibiotic stewardship and assess their effectiveness in reducing antibiotic prescribing. We searched PubMed, Embase, Web of Science, and Scopus for peer-reviewed studies published between Jan 1, 2000, and Jan 20, 2022. 3547 studies were screened, of which 23 studies reporting the effects of social norm feedback interventions on antibiotic prescribing met the inclusion criteria. 19 behaviour change techniques were tested in the included studies. The meta-analyses showed that social norm feedback is an effective strategy for reducing antibiotic prescribing, with an overall rate difference of 4% (p<0·0001). The behaviour change technique with the highest effective ratio (ER=13) was information about health consequences, followed by instruction on how to perform the behaviour (ER=9) and adding objects to the environment (ER=9). Social norm feedback is a promising strategy to reduce antibiotic prescribing, and can be incorporated into the clinical decision-making support system.
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24
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Duan L, Liu C, Wang D, Lin R, Qian P, Zhang X, Liu C. The vicious cycle of the public's irrational use of antibiotics for upper respiratory tract infections: A mixed methods systematic review. Front Public Health 2022; 10:985188. [PMID: 36339167 PMCID: PMC9632431 DOI: 10.3389/fpubh.2022.985188] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/27/2022] [Indexed: 01/25/2023] Open
Abstract
Background The public's irrational use of antibiotics for upper respiratory tract infections (URTIs) is prevalent worldwide. This study aims to synthesize evidence on how people use antibiotics to treat URTIs, its prevalence and determinants. Methods A mixed methods systematic review was conducted using a convergent segregated approach. Relevant studies were searched from PubMed, Cochrane Library, Embase, and Web of Science. A qualitative analysis was initiated, exploring the public's antibiotic use experience for URTIS based on the Consumer Behavior Model (CBM). This was followed by a quantitative synthesis, tapping into the prevalence and predictors of public behavior in antibiotic usage for URTIs. The segregated syntheses complemented each other and were further integrated. Results A total of 86 studies were included: 48 quantitative, 30 qualitative, eight mixed methods studies. The included studies were conducted in Europe (n = 29), Asia (n = 27) and North America (n = 21), assessing the behaviors of patients (n = 46), their parents or caregivers (n = 31), or both (n = 9). Eleven themes emerged covering the six CBM stages: need recognition, information searching, alternative evaluation, antibiotic obtaining, antibiotic consumption, and post-consumption evaluation. The six stages reinforce each other, forming a vicious cycle. The high prevalence of the public's irrational use of antibiotics for URTIs is evident despite the high heterogeneity of the studies (ranging from 0.0 to 92.7%). The perceived seriousness of illness and misbelief in antibiotics were identified consistently across the studies as the major motivation driving the public's irrational use of antibiotics for URTIs. However, individual capacity (e.g., knowledge) and opportunity (e.g., contextual restriction) in reducing antibiotic use have mixed effect. Conclusion Systemic interventions concerning both supply and demand sides are warranted. The public needs to be educated about the appropriate management of URTIs and health care providers need to re-shape public attitudes toward antibiotic use for URTIs through communication and prescribing practices. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier: CRD42021266407.
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Affiliation(s)
- Lixia Duan
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Dan Wang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Rujiao Lin
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Pan Qian
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
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25
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Kühn L, Kronsteiner D, Kaufmann-Kolle P, Andres E, Szecsenyi J, Wensing M, Poss-Doering R. Implementation fidelity in a multifaceted program to foster rational antibiotics use in primary care: an observational study. BMC Med Res Methodol 2022; 22:243. [PMID: 36123597 PMCID: PMC9487096 DOI: 10.1186/s12874-022-01725-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ARena study (Sustainable Reduction of Antimicrobial Resistance in German Ambulatory Care) is a three-arm, cluster randomized trial to evaluate a multifaceted implementation program in a German primary care setting. In the context of a prospective process evaluation conducted alongside ARena, this study aimed to document and explore fidelity of the implementation program. METHODS This observational study is based on data generated in a three-wave survey of 312 participating physicians in the ARena program and attendance documentation. Measures concerned persistence of participation in the ARena program and adherence to intervention components (thematic quality circles, e-learning, basic expenditure reimbursements, additional bonus payments and a computerized decision support system). Participants' views on five domains of the implementation were also measured. Binary logistic and multiple linear regression analyses were used to explore which views on the implementation were associated with participants' adherence to quality circles and use of additional bonus compensation. RESULTS The analysis of fidelity showed overall high persistence of participation in the intervention components across the three intervention arms (90,1%; 97,9%; 92,9%). 96.4% of planned quality circles were delivered to study participants and, across waves, 30.4% to 93% of practices participated; 56.1% of physicians attended the maximum of four quality circles. 84% of the practices (n = 158) with a minimum of one index patient received a performance-based additional bonus payment at least once. In total, bonus compensation was triggered for 51.8% of affected patients. Participation rate for e-learning (a prerequisite for reimbursement of project-related expenditure) covered 90.8% of practices across all intervention arms, with the highest rate in arm II (96.5%). Uptake of expenditure reimbursement was heterogeneous across study arms, with a mean rate of 86.5% (89.1% in arm I, 96.4% in arm II and 74.1% in arm III). Participants' views regarding participant responsiveness (OR = 2.298) 95% CI [1.598, 3.305] and Context (OR = 2.146) 95% CI [1.135, 4.055] affected additional bonus payment. Participants' views on participant responsiveness (Beta = 0.718) 95% CI [0.479, 0.957], Context (Beta = 0.323) 95% CI [0.055, 0.590] and Culture of shared decision-making (Beta = -0.334) 95% CI [-0.614, -0.053] affected quality circle attendance. CONCLUSION This study showed an overall high fidelity to the implementation program. Participants' views on the implementation were associated with degree of intervention fidelity. TRIAL REGISTRATION ISRCTN, ISRCTN58150046.
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Affiliation(s)
- Lukas Kühn
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | | | - Edith Andres
- aQua Institut, Maschmuehlenweg 8-10, 37073, Goettingen, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.,aQua Institut, Maschmuehlenweg 8-10, 37073, Goettingen, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Regina Poss-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
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Cai HTN, Tran HT, Nguyen YHT, Vu GQT, Tran TP, Bui PB, Nguyen HTT, Pham TQ, Lai AT, Van Nuil JI, Lewycka S. Challenges and Lessons Learned in the Development of a Participatory Learning and Action Intervention to Tackle Antibiotic Resistance: Experiences From Northern Vietnam. Front Public Health 2022; 10:822873. [PMID: 35958847 PMCID: PMC9362799 DOI: 10.3389/fpubh.2022.822873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/22/2022] [Indexed: 12/02/2022] Open
Abstract
Antibiotic use in the community for humans and animals is high in Vietnam, driven by easy access to over-the counter medicines and poor understanding of the role of antibiotics. This has contributed to antibiotic resistance levels that are amongst the highest in the world. To address this problem, we developed a participatory learning and action (PLA) intervention. Here we describe challenges and lessons learned while developing and testing this intervention in preparation for a large-scale One Health trial in northern Vietnam. We tested the PLA approach using community-led photography, and then reflected on how this approach worked in practice. We reviewed and discussed implementation documentation and developed and refined themes. Five main themes were identified related to challenges and lessons learned: understanding the local context, stakeholder relationship development, participant recruitment, building trust and motivation, and engagement with the topic of antibiotics and antimicrobial resistance (AMR). Partnerships with national and local authorities provided an important foundation for building relationships with communities, and enhanced visibility and credibility of activities. Partnership development required managing relationships, clarifying roles, and accommodating different management styles. When recruiting participants, we had to balance preferences for top-down and bottom-up approaches. Building trust and motivation took time and was challenged by limited study team presence in the community. Open discussions around expectations and appropriate incentives were re-visited throughout the process. Financial incentives provided initial motivation to participate, while less tangible benefits like collective knowledge, social connections, desire to help the community, and new skills, sustained longer-term motivation. Lack of awareness and perceived importance of the problem of AMR, affected initial motivation. Developing mutual understanding through use of common and simplified language helped when discussing the complexities of this topic. A sense of ownership emerged as the study progressed and participants understood more about AMR, how it related to their own concerns, and incorporated their own ideas into activities. PLA can be a powerful way of stimulating community action and bringing people together to tackle a common problem. Understanding the nuances of local power structures, and allowing time for stakeholder relationship development and consensus-building are important considerations when designing engagement projects.
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Affiliation(s)
| | - Hang Thi Tran
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | | | | | | | | | - Huong Thi Thu Nguyen
- Communicable Disease Control and Prevention, National Institute for Hygiene and Epidemiology, Hanoi, Vietnam
| | - Thai Quang Pham
- Communicable Disease Control and Prevention, National Institute for Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sonia Lewycka
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- *Correspondence: Sonia Lewycka
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27
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Restriction on antimicrobial dispensing without prescription on a national level: Impact on the overall antimicrobial utilization in the community pharmacies in Saudi Arabia. PLoS One 2022; 17:e0271188. [PMID: 35881572 PMCID: PMC9321410 DOI: 10.1371/journal.pone.0271188] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background High rates of non-prescription dispensing of antimicrobials have led to a significant increase in the antimicrobial overuse and misuse in Saudi Arabia (SA). The objective of this study was to evaluate the antimicrobial utilization following the enforcement of a new prescription-only antimicrobial dispensing policy in the community pharmacy setting in SA. Methods Data were extracted from the IQVIA database between May 2017 and May 2019. The antimicrobial utilization rates, based on sales, defined daily dose in grams (DDD), DDD/1000 inhabitants/day (DID), and antimicrobial-claims for the pre-policy (May 2017 to April 2018) and post-policy (June 2018 to May 2019) periods were assessed. Results Overall antimicrobial utilization declined slightly (~9–10%) in the post-policy versus pre-policy period (sales, 31,334 versus 34,492 thousand units; DDD, 183,134 versus 202,936), with higher claims (~16%) after policy implementation. There was a sudden drop in the utilization rate immediately after policy enforcement; however, the values increased subsequently, closely matching the pre-policy values. Utilization patterns were similar in both periods; penicillin was the most used antimicrobial (sales: 11,648–14,700–thousand units; DDD: 71,038–91,227; DID: 2.88–3.78). For both periods, the highest dip in utilization was observed in July (sales: 1,027–1,559 thousand units; DDD: 6,194–9,399), while the highest spike was in March/October (sales: 3,346–3,884 thousand units; DDD: 22,329–19,453). Conclusion Non-prescription antimicrobial utilization reduced minimally following policy implementation in the community pharmacies across SA. Effective implementation of prescription-only regulations is necessary.
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Visschers VHM, Feck V, Herrmann A. Knowledge, Social Influences, Perceived Risks and Benefits, and Cultural Values Explain the Public's Decisions Related to Prudent Antibiotic Use. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:1488-1503. [PMID: 34784422 PMCID: PMC9544676 DOI: 10.1111/risa.13851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
People should use antibiotics (AB) prudently to mitigate antibiotic resistance (ABR). Previous studies-and, subsequently, interventions-on ABR have focused mainly on improving public awareness and knowledge. We investigated a comprehensive theory-based explanatory model to understand the public's decision making regarding prudent AB use, based on, among others, the theory of planned behavior. In a cross-sectional online survey, the psychological determinants of people's decisions about prudent AB use were examined in a sample of 1,228 Swiss adults. The questionnaire assessed respondents' demand for AB, willingness to adopt measures that prevent the need for AB, perceived risks of ABR, perceived benefits of AB, attitudes and social influences regarding AB, knowledge of AB and ABR, and cultural values. Mokken scale analysis revealed three types of knowledge: knowledge of the functioning of AB, of ABR, and of preventive measures. Structural equation modeling indicated that respondents' demand for AB was mostly predicted by social influences, perceived benefits of AB, and knowledge of AB functioning. Willingness to prevent AB use was mainly related to conservative values, perceived risks of ABR, negative attitudes toward AB, and knowledge of preventive measures. Our study suggests that the provision of information about AB and preventive measures is a first step toward changing people's decisions related to prudent AB use. Future interventions that additionally utilize cultural values to convey important messages and target additional factors, such as social influences, the risks of ABR, and the benefits of cautious AB use, can be more successful in promoting prudent AB use.
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Affiliation(s)
- Vivianne H. M. Visschers
- School of Applied PsychologyUniversity of Applied Sciences and Arts Northwestern SwitzerlandOltenSwitzerland
| | - Vanessa Feck
- School of Applied PsychologyUniversity of Applied Sciences and Arts Northwestern SwitzerlandOltenSwitzerland
| | - Anne Herrmann
- School of Applied PsychologyUniversity of Applied Sciences and Arts Northwestern SwitzerlandOltenSwitzerland
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29
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Rostkowska OM, Raczkiewicz D, Knap-Wielgus W, Zgliczyński WS. Polish Medical Doctors' Opinions on Available Resources and Information Campaigns concerning Antibiotics and Antibiotic Resistance, a Cross-Sectional Study. Antibiotics (Basel) 2022; 11:882. [PMID: 35884136 PMCID: PMC9311609 DOI: 10.3390/antibiotics11070882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Antibiotic resistance (ABR) is at the top of global health threats. This paper aims to assess Polish physicians' readiness to impact ABR through prescribing routines. Methods: Surveying Polish physicians participating in specialization courses at the Center for Postgraduate Medical Education in Warsaw, Poland from October 2019 to March 2020. Results: Information was obtained from 504 physicians aged 25-59, mean 32.8 ± 5.9 years, mainly women (65%). Most doctors (78%) prescribed antibiotics at least once a week. Physicians indicated clinical practice guidelines as resources most often consulted in the management of infections (90%). However, clinical experience was also declared a powerful resource. In total, 54% of respondents recalled receiving information about the prudent use of antibiotics within 12 months, which partially translated into changing views (56%) and practice (42%). Physicians disagreed that national campaigns provide good promotion of prudent antibiotics use (75%) or that they are effective (61%). Only 40% of doctors were aware of the national campaign promoting responsible antibiotics use, 24% had heard about the European Antibiotic Awareness Day and 20% knew about the World Antimicrobial Awareness Week. Conclusions: Prescribers most often rely on clinical practice guidelines and their own experience as resources for antibiotics use. Doctors' awareness of available resources and information campaigns concerning antibiotics and antibiotic resistance should be improved.
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Affiliation(s)
- Olga Maria Rostkowska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland;
| | - Dorota Raczkiewicz
- Department of Medical Statistics, School of Public Health, Center of Postgraduate Medical Education, 01-826 Warsaw, Poland;
| | - Weronika Knap-Wielgus
- Infant Jesus Clinical Hospital, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Wojciech Stefan Zgliczyński
- Department of Lifestyle Medicine, School of Public Health, Center of Postgraduate Medical Education, 01-826 Warsaw, Poland
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30
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Alejandro AL, Bruce M, Leo C. Parents' awareness of antimicrobial resistance: a qualitative study utilising the Health Belief Model in Perth, Western Australia. Aust N Z J Public Health 2022; 46:764-770. [PMID: 35679064 DOI: 10.1111/1753-6405.13265] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aimed to determine local factors that promote or prevent parents' responsible use of antibiotics for their children in Perth, Western Australia. METHODS The Health Belief Model was used to guide this study. Four focus group discussions were conducted, with 26 participants. Participants were recruited purposively through a parent group organisation. The Framework Method was utilised to analyse the data. RESULTS Participants agreed that antimicrobial resistance (AMR) is a serious health problem. However, participants admitted that they lacked awareness of AMR, inhibiting their ability to assess the risks of developing AMR infections among their children. Participants knew the indications and risks of antibiotic use but still viewed antibiotics as a time-saving solution that minimised disruption to their routine. Participants' previous experiences in managing their children's illness increased their confidence and linked their positive and negative experiences with their general practitioners in their judicious use of antibiotics. CONCLUSIONS While parents demonstrated awareness of the indications of antibiotics, they continue to lack AMR awareness and overvalue antibiotics. IMPLICATIONS FOR PUBLIC HEALTH The findings highlight that incorporating parent empowerment and participation in decision-making regarding antibiotics use, and maintaining a positive relationship with healthcare providers, were important strategies to encourage the appropriate use of antibiotics.
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Affiliation(s)
- Aaron Lapuz Alejandro
- Centre for Biosecurity and One Health, Murdoch University, Fiona Stanley Hospital, Western Australia
| | - Mieghan Bruce
- School of Veterinary Science, Centre for Biosecurity and One Health, Murdoch University, Western Australia
| | - Cheryl Leo
- School of Business and Governance, Murdoch University, Western Australia
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Song M, Deng Z, Chan O, Grépin KA. Understanding the Implementation of Antimicrobial Policies: Lessons from the Hong Kong Strategy and Action Plan. Antibiotics (Basel) 2022; 11:antibiotics11050636. [PMID: 35625280 PMCID: PMC9138146 DOI: 10.3390/antibiotics11050636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 01/27/2023] Open
Abstract
In 2017, the Hong Kong Strategy and Action Plan on Antimicrobial Resistance 2017–2022 (HKSAP) was announced with the aim of tackling the growing threat of antimicrobial resistance (AMR) in Hong Kong. However, little is known about how the planned activities have been implemented. In this study, we examine the status of implementation of the HKSAP using the Smith Policy Implementation Process Model. Semi-structured interviews with 17 informants found that important achievements have been made, including launching educational and training activities targeting the public, farmers, and healthcare professionals; upgrading the AMR surveillance system; and strengthening AMR stewardship and infection control. Nevertheless, participants also identified barriers to greater implementation, such as tensions across sectors, ongoing inappropriate drug use and prescription habits, insufficient human and technical resources, as well as a weak accountability framework. Environmental factors such as the COVID-19 pandemic also affected the implementation of HKSAP. Our study indicated that expanding engagement with the public and professionals, creating a collaborative environment for policy implementation, and building a well-functioning monitoring and evaluation system should be areas to focus on in future AMR policies.
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Simegn W, Dagnew B, Weldegerima B, Dagne H. Knowledge of Antimicrobial Resistance and Associated Factors Among Health Professionals at the University of Gondar Specialized Hospital: Institution-Based Cross-Sectional Study. Front Public Health 2022; 10:790892. [PMID: 35372208 PMCID: PMC8966026 DOI: 10.3389/fpubh.2022.790892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Antimicrobial resistance is one of the many health challenges worldwide, particularly in resource-limited countries like Ethiopia. Increasing knowledge of health professionals can reduce the occurrence of antimicrobial resistance. In this study, we determined the antimicrobial resistance knowledge and examined the associated factors among the University of Gondar Hospital health professionals. Methods An institution-based cross-sectional survey was carried out. The samples were randomly recruited. Statistical analysis was performed by using the statistical package for social sciences (SPSS) version 20 after entering the data using Epidemiological information (Epi-Info). To identify associated factors, the authors executed binary logistic regression and multivariate analysis wherein the statistical significance was decided at p < 0.05. Results Four hundred and twelve health professionals with ages ranging from 20-60 years and mean age of 29.9 years took part in the study. Fifty-three-point-four percent of participants were males. The majority of the total respondents (84.7%, 95% CI: 80.08–88.30) had good knowledge of antimicrobial resistance. It was found that being male (AOR = 1.94, 95% CI: 1.10, 3.52), a work experience of 6–10 years (AOR = 2.45, 95% CI: 1.28, 4.68), having 30–38working hours per week (AOR = 3.93, 95% CI: 1.38, 5.11), and antibiotic intake (AOR = 3.71, 95% CI: 1.75, 7.87) were significant factors of antimicrobial resistance knowledge. Conclusion In the current study, about 84.5% of health professionals had good knowledge of antimicrobial resistance. Reducing working hours per week and increasing the experience of workers are recommended to increase the knowledge on AMR.
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Affiliation(s)
- Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Berhanemeskel Weldegerima
- Department of Social and Administrative Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Henok Dagne
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Ford K, Bellis MA, Hill R, Hughes K. An evaluation of a short film promoting kindness in Wales during COVID-19 restrictions #TimeToBeKind. BMC Public Health 2022; 22:583. [PMID: 35331188 PMCID: PMC8944183 DOI: 10.1186/s12889-022-12876-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In response to successive COVID-19 restrictions in Wales, the Welsh ACE Support Hub launched the #TimeToBeKind campaign in March 2021. The campaign used a short film broadcast on national television and promoted on social media to encourage behaviour change for kindness. We evaluated the #TimeToBeKind campaign film to identify whether watching the film would result in increased intention to act in ways that promote kindness to others and if intentions were associated with being emotionally affected by the film. METHODS A mixed methods evaluation was employed, using a short online survey and interaction with the film on the Twitter social media platform. The online survey measured public (n = 390) attitudes towards the film including feelings invoked, and behavioural intentions for acts of kindness as a result of viewing the film. Tweets which interacted with the film (n = 59; likes, re-tweets or comments), and tweet sentiment (positive, negative, or neutral) towards the film were also explored. RESULTS The majority of participants reported positive attitudes to the film and agreed that they understood the campaign message (91.8%). 67.9% reported that the film made them feel upset or sad and for 22.6% the film resonated with their lockdown experience. As a result of seeing the film, 63.6% reported intentions to be kinder to others, 65.6% intended to try and help other members of their community, and 70.5% were more likely to check in on friends, family and neighbours. A higher proportion of individuals who were emotionally affected by the film (e.g. upset or sad, hopeful or encouraged, gained something positive) and those for whom the film resonated with their lockdown experience reported increased kindness behavioural intentions as a result of seeing the film. CONCLUSIONS Film can be an effective tool to promote behaviour change for kindness. Films that provoke strong emotional reactions can still be perceived positively and lead to behaviour change. With the COVID-19 pandemic accelerating a move online for many, the findings of the present evaluation are relevant to how public health messaging can adapt and utilise this space to target individuals and promote behaviour change.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, LL13 7YP, Wrexham, UK.
| | - Mark A Bellis
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, LL13 7YP, Wrexham, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, LL13 7YP, Wrexham, UK
| | - Rebecca Hill
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, CF10 4BZ, Cardiff, UK
| | - Karen Hughes
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, LL13 7YP, Wrexham, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, LL13 7YP, Wrexham, UK
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Hawkins O, Scott AM, Montgomery A, Nicholas B, Mullan J, van Oijen A, Degeling C. Comparing public attitudes, knowledge, beliefs and behaviours towards antibiotics and antimicrobial resistance in Australia, United Kingdom, and Sweden (2010-2021): A systematic review, meta-analysis, and comparative policy analysis. PLoS One 2022; 17:e0261917. [PMID: 35030191 PMCID: PMC8759643 DOI: 10.1371/journal.pone.0261917] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/13/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Social and behavioural drivers of inappropriate antibiotic use contribute to antimicrobial resistance (AMR). Recent reports indicate the Australian community consumes more than twice the defined daily doses (DDD) of antibiotics per 1000 population than in Sweden, and about 20% more than in the United Kingdom (UK). We compare measures of public knowledge, attitudes and practices (KAP) surrounding AMR in Australia, the UK and Sweden against the policy approaches taken in these settings to address inappropriate antibiotic use. METHODS National antimicrobial stewardship policies in Australia, Sweden, and the UK were reviewed, supplemented by empirical studies of their effectiveness. We searched PubMed, EMBASE, PsycINFO, Web of Science and CINAHL databases for primary studies of the general public's KAP around antibiotic use and AMR in each setting (January 1 2011 until July 30 2021). Where feasible, we meta-analysed data on the proportion of participants agreeing with identical or very similar survey questions, using a random effects model. RESULTS Policies in Sweden enact tighter control of community antibiotic use; reducing antibiotic use through public awareness raising is not a priority. Policies in the UK and Australia are more reliant on practitioner and public education to encourage appropriate antibiotic use. 26 KAP were included in the review and 16 were meta-analysable. KAP respondents in Australia and the UK are consistently more likely to report beliefs and behaviours that are not aligned with appropriate antibiotic use, compared to participants in similar studies conducted in Sweden. CONCLUSIONS Interactions between public knowledge, attitudes and their impacts on behaviours surrounding community use of antibiotics are complex and contingent. Despite a greater focus on raising public awareness in Australia and the UK, neither antibiotic consumption nor community knowledge and attitudes are changing significantly. Clearly public education campaigns can contribute to mitigating AMR. However, the relative success of policy approaches taken in Sweden suggests that practice level interventions may also be required to activate prescribers and the communities they serve to make substantive reductions in inappropriate antibiotic use.
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Affiliation(s)
- Olivia Hawkins
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Queensland, Australia
| | - Amy Montgomery
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Bevan Nicholas
- Illawarra-Shoalhaven Local Health District, NSW Health, Wollongong, NSW, Australia
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Antoine van Oijen
- Molecular Horizons, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
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Allen T, Gyrd-Hansen D, Kristensen SR, Oxholm AS, Pedersen LB, Pezzino M. Physicians under Pressure: Evidence from Antibiotics Prescribing in England. Med Decis Making 2022; 42:303-312. [PMID: 35021900 PMCID: PMC8918864 DOI: 10.1177/0272989x211069931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many physicians are experiencing increasing demands from both their patients and society. Evidence is scarce on the consequences of the pressure on physicians' decision making. We present a theoretical framework and predict that increasing pressure may make physicians disregard societal welfare when treating patients. SETTING We test our prediction on general practitioners' antibiotic-prescribing choices. Because prescribing broad-spectrum antibiotics does not require microbiological testing, it can be performed more quickly than prescribing for narrow-spectrum antibiotics and is therefore often preferred by the patient. In contrast, from a societal perspective, inappropriate prescribing of broad-spectrum antibiotics should be minimized as it may contribute to antimicrobial resistance in the general population. METHODS We combine longitudinal survey data and administrative data from 2010 to 2017 to create a balanced panel of up to 1072 English general practitioners (GPs). Using a series of linear models with GP fixed effects, we estimate the importance of different sources of pressure for GPs' prescribing. RESULTS We find that the percentage of broad-spectrum antibiotics prescribed increases by 6.4% as pressure increases on English GPs. The link between pressure and prescribing holds for different sources of pressure. CONCLUSIONS Our findings suggest that there may be societal costs of physicians working under pressure. Policy makers need to take these costs into account when evaluating existing policies as well as when introducing new policies affecting physicians' work pressure. An important avenue for further research is also to determine the underlying mechanisms related to the different sources of pressure.JEL-code: I11, J28, J45. HIGHLIGHTS Many physicians are working under increasing pressure.We test the importance of pressure on physicians' prescribing of antibiotics.The prescribed rate of broad-spectrum antibiotics increases with pressure.Policy makers should be aware of the societal costs of pressured physicians.[Formula: see text].
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Affiliation(s)
- Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK.,Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Dorte Gyrd-Hansen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Søren Rud Kristensen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark.,Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Anne Sophie Oxholm
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Line Bjørnskov Pedersen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark.,Research Unit for General Practice, University of Southern Denmark, J..B, Odense C, Denmark
| | - Mario Pezzino
- School of Social Sciences, University of Manchester, Manchester, UK
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OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1216. [DOI: 10.1093/jac/dkac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Point of care testing, antibiotic prescribing and prescribing confidence for respiratory tract infections in primary care: Prospective audit in 18 European countries. BJGP Open 2021; 6:BJGPO.2021.0212. [PMID: 34920989 PMCID: PMC9447323 DOI: 10.3399/bjgpo.2021.0212] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/03/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Between-country differences have been described in antibiotic prescribing for RTI in primary care, but not yet for diagnostic testing procedures and prescribing confidence. AIM To describe between-country differences in RTI management, particularly diagnostic testing and antibiotic prescribing, and investigate which factors relate to antibiotic prescribing and GPs' prescribing confidence. DESIGN & SETTING Prospective audit in 18 European countries. METHOD GPs registered patient-, clinical- and management characteristics, and confidence in their antibiotic prescribing decision for patients presenting with sore throat and/or lower RTI (n=4,982). Factors related to antibiotic prescribing and confidence were analysed using multi-level logistic regression. RESULTS Antibiotic prescribing proportions varied considerably:<20% in four countries, and >40% in six countries. There was also considerable variation in POC testing (0% in Croatia, Moldova, Romania, and >65% in Denmark, Norway, mainly CRP and Strep A), and in lab/hospital-based testing (<3% in Hungary, Netherlands, Spain, and >30% in Croatia, Georgia, Greece, Moldova, mainly chest X-ray and white blood cell counting). Antibiotic prescribing was related to illness severity, comorbidity, age, fever and 'country', but not to having performed a POC test. In nearly 90% of consultations, GPs were confident in their antibiotic prescribing decision. CONCLUSION Despite high confidence in decisions about antibiotic prescribing, there is considerable variation in the primary care of RTI in European countries, with GPs prescribing antibiotics overall more often than is considered appropriate. POC testing may enhance the quality of antibiotic prescribing decisions if it can safely reverse decisions confidently made on clinical grounds alone to prescribe antibiotics.
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A Peer Educational Tool to Promote Antimicrobial Stewardship on a University Campus. PHARMACY 2021; 9:pharmacy9040199. [PMID: 34941631 PMCID: PMC8703290 DOI: 10.3390/pharmacy9040199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Antibiotic resistance is a major public health threat. Patient education on the appropriate use of antibiotics is a key component in combating antimicrobial resistance. The purpose of this study was to analyze the utility of an origami fortune teller as a novel peer educational tool in promoting antimicrobial stewardship on a university campus. An origami fortune teller, with various case scenarios to demonstrate key antibiotic principles, was developed and used by peer educators to educate students attending a university wellness fair. The case studies included: antibiotic indications; differentiation between viral vs. bacterial infection; proper use of antibiotics; non-pharmacologic measures to combat infection; and antibiotic resistance. Students were asked to take an assessment pre and post working with the tool. One hundred and forty-three students received education using the novel tool. A significant improvement in the assessment score was observed after education was completed using the novel tool (69.5 vs. 96.6 p ≤ 0.05).
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Zhou Z, Zhao D, Zhang H, Shen C, Cao D, Liu G, Zhu L, Fang Y. Understanding parental self-medication with antibiotics among parents of different nationalities: a cross-sectional study. Glob Health Res Policy 2021; 6:42. [PMID: 34696814 PMCID: PMC8543833 DOI: 10.1186/s41256-021-00226-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/14/2021] [Indexed: 01/21/2023] Open
Abstract
Background There is an increasing trend on the practices of parental self-medication with antibiotics (PSMA) around world, accelerating the antibiotic abuse. This study aims to examine the nationality differences in the practices of PSMA and knowledge, attitudes and practices (KAP) toward antibiotic use, and understand the practices of PSMA among parents of various nationalities in China. Methods A cross-sectional study based on a structured questionnaire survey was conducted in Xi’an, Shaanxi Province, China, from September 2018 to October 2018. A total of 299 respondents participated in. The practices of PSMA (a dichotomous variable) and KAP toward antibiotic use (a continuous variable) served as dependent variables. Participant’s nationality was regarded as the independent variable. Binary logistic regression and ordinary least square regression were employed to examine the association between parent’s nationality and the practices of PSMA, and KAP toward antibiotic use, respectively. Results 121 (40.88%) Chinese, 100 (33.76%) other Asians and 75 (25.34%) Occidentals were included in final analysis, with a sample size of 296. Chinese were more likely to practice PSMA (OR = 7.070; 95% CI 1.315, 38.01), with worse knowledge (Coef. = − 0.549; 95% CI − 1.021, − 0.078), attitudes (Coef. = − 3.069; 95% CI − 4.182, − 1.956) and practices (Coef. = − 1.976; 95% CI − 3.162, − 0.790) toward antibiotic use, compared to their Occidental counterparts. The main reasons for the practices of PSMA were enough previous medication experience (80.49%) and same ailments with no need to see a doctor (39.02%), with common symptoms such as fever (60.98%) and cough (58.54%). Purchasing antibiotics at pharmacies (92.08%) and using leftover antibiotics (26.83%) were usual approaches. Conclusions The study highlights the gaps in the practices of PSMA and KAP toward antibiotic use among parents of different nationalities. The access to obtain antibiotics from pharmacies reflects the pharmacists’ unaware of laws on prescription of antibiotics, fierce competition in the pharmacy market, and the government’s lax supervision in China. It suggests the need to improve pharmacists’ training, enforce current legislations on pharmacy market regarding the sale of antibiotics, and provide practical and effective educational interventions for residents about antibiotic use. Supplementary Information The online version contains supplementary material available at 10.1186/s41256-021-00226-y.
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Affiliation(s)
- Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Dantong Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Huarui Zhang
- Xi'an Lianhu District Huoshaobei Clinic, Xi'an, China
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Dan Cao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Guanping Liu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Liang Zhu
- Department of Health Care Management and Medical Education, School of Military Preventive Medicine, Air Force Medical University, Xi'an, China.
| | - Yu Fang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, China
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Altorkmani A, Alzabibi MA, Shibani M, Ismail H, Sawaf B, Daher N, Al-Moujahed A. Assessing the Syrian Population's Knowledge, Attitudes, and Practices Regarding Antibiotic Usage. Avicenna J Med 2021; 11:132-138. [PMID: 34646789 PMCID: PMC8500066 DOI: 10.1055/s-0041-1732815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Antibiotic resistance is a serious public health threat that results mainly secondary to antibiotics misuse. The present study aimed to determine the knowledge, attitude, and practice toward antibiotic use among the Syrian population. Methods This cross-sectional study was conducted at the outpatient clinics of two major hospitals in Damascus, Syria. Applying a random convenience sampling, data were collected in a 1-week period by interviewing participants using a structured questionnaire, which targeted demographics, practice, knowledge, and attitude. Data were used to assess the relationship between the knowledge level and attitudes and demographics. Results Most respondents had a moderate level of knowledge (187, 74.8%) and a moderate attitude score (148, 59.2%). In addition, most respondents (149, 59.6%) stated that they take antibiotics based on pharmacist advice only and do not complete the full antibiotic course (200, 80%). A significant association was found between the knowledge level and financial status ( p -value = 0.003), education level ( p -value = 0.001), and having relatives working in the health care sector ( p -value = 0.021). In addition, a significant association was found between the attitude and having health insurance. Conclusion This study provides baseline evidence about the knowledge, attitudes, and practices regarding antibiotics among the Syrian population, that will help in designing targeted interventions to solve the inappropriate use of antibiotics.
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Affiliation(s)
- Abdallah Altorkmani
- Faculty of Medicine, Department of Internal Medicine, Syrian Private University, Damascus, Syria
| | - Mhd Amin Alzabibi
- Faculty of Medicine, Department of Internal Medicine, Syrian Private University, Damascus, Syria
| | - Mosa Shibani
- Faculty of Medicine, Department of Internal Medicine, Syrian Private University, Damascus, Syria
| | - Hlma Ismail
- Faculty of Medicine, Department of Internal Medicine, Syrian Private University, Damascus, Syria
| | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nizar Daher
- Faculty of Medicine, Department of Internal Medicine, Syrian Private University, Damascus, Syria
| | - Ahmad Al-Moujahed
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Stanford, California, United States
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Lo ACY, Li JTS, Chau JPC, Wong SYS, Hui DSC, Lee VWY. Impact of interprofessional service-learning on the effectiveness of knowledge transfer of antimicrobial resistance to Hong Kong elders: a quasi-experiment. Antimicrob Resist Infect Control 2021; 10:145. [PMID: 34641950 PMCID: PMC8506482 DOI: 10.1186/s13756-021-01011-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Community perception on antimicrobials plays a role in driving the development of antimicrobial resistance (AMR). The aim of the study was to evaluate the impact of interprofessional service-learning on the effectiveness of AMR knowledge transfer in Hong Kong elders aged 65 or above and students from university and secondary schools.
Methods A quasi-experimental pretest–posttest controlled study was carried out from July 2018 to March 2019 for elderly subjects and a pre- and post-test were conducted in students from May to August 2018. Elderly subjects were recruited from the university-based community outreach program. The community outreach team consisted of both university and secondary school students. Students were provided with training of geriatric care and AMR before they reached out to the community. The one-to-one intervention with the aid of video and verbal explanation to educate the elderly about the definition, causes, and consequences of AMR, and preventive measures against AMR was provided. Questionnaires on knowledge of antibiotics and AMR were used as tools to reflect on the effectiveness for both students and elderly subjects. The questionnaire was completed twice, before and 1 week after the intervention. Chi-square test, t tests and regression analysis were used to analyze the data. Results A total of 93 Chinese elders, 61 of them in the intervention group and 32 in the control group participated in the study. The score obtained by the intervention group increased from 40.1 to 83.3% (p < 0.001) following intervention, while that of control group increased from 33.0 to 44.0% (p < 0.001). The increase attained in the intervention group was significantly greater than that of the control group (p < 0.001). A total of 95 secondary students and 88 university students have completed the pre-post questionnaires with 42.21% and 13% increment in AMR knowledge after the training (p < 0.001). Conclusion The significant change in knowledge level showed effective AMR knowledge transfer to both elders and students. The study could be used as a reference when allocating resources to implement effective interprofessional service-learning for better community health education in elderly populations. Trial registration: This study was approved by the Chinese University of Hong Kong Survey and Behavioural Research Ethics Committee in December 2018 (Ref no. SBRE-18-214).
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Affiliation(s)
- Anna C Y Lo
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Joyce T S Li
- Centre for Learning Enhancement And Research, The Chinese University of Hong Kong (CLEAR), Room 502 Hui Yeung Shing Building, Shatin, N.T., Hong Kong
| | - Janita P C Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Samuel Y S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - David S C Hui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Vivian W Y Lee
- Centre for Learning Enhancement And Research, The Chinese University of Hong Kong (CLEAR), Room 502 Hui Yeung Shing Building, Shatin, N.T., Hong Kong.
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Bruyndonckx R, Hoxha A, Quinten C, Ayele GM, Coenen S, Versporten A, Adriaenssens N, Muller A, Heuer O, Monnet DL, Goossens H, Molenberghs G, Weist K, Hens N. Change-points in antibiotic consumption in the community, European Union/European Economic Area, 1997-2017. J Antimicrob Chemother 2021; 76:ii68-ii78. [PMID: 34312659 PMCID: PMC8314102 DOI: 10.1093/jac/dkab179] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Surveillance of antibiotic consumption in the community is of utmost importance to inform and evaluate control strategies. Data on two decades of antibiotic consumption in the community were collected from 30 EU/European Economic Area (EEA) countries. This article reviews temporal trends and the presence of abrupt changes in subgroups of relevance in antimicrobial stewardship. METHODS For the period 1997-2017, data on yearly antibiotic consumption in the community, aggregated at the level of the active substance, were collected using the WHO ATC classification and expressed in DDD (ATC/DDD index 2019) per 1000 inhabitants per day. We applied a range of non-linear mixed models to assess the presence of changes in the consumption of antibacterials for systemic use (ATC group J01) and eight antibiotic subgroups. RESULTS For the majority of the studied groups, a country-specific change-point model provided the best fit. Depending on the antibiotic group/subgroup and on the country, change-points were spread out between 2000 and 2013. CONCLUSIONS Due to the heterogeneity in antibiotic consumption in the community across EU/EEA countries, a country-specific change-point model provided the better fit. Given the limitations of this model, our recommendation for the included countries is to carefully interpret the country-specific results presented in this article and to use the tutorial included in this series to conduct their own change-point analysis when evaluating the impact of changes in regulations, public awareness campaigns, and other national interventions to improve antibiotic consumption in the community.
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Affiliation(s)
- Robin Bruyndonckx
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
| | | | - Chantal Quinten
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Centre for General Practice, Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Centre for General Practice, Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Arno Muller
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Ole Heuer
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Dominique L Monnet
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Catholic University of Leuven, Leuven, Belgium
| | - Klaus Weist
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Chatterjee S, Hazra A, Chakraverty R, Shafiq N, Pathak A, Trivedi N, Sadasivam B, Kakkar AK, Jhaj R, Kaul R, Kshirsagar N. A multicentric knowledge-attitude-practice survey in the community about antimicrobial use and resistance in India. Trans R Soc Trop Med Hyg 2021; 115:785-791. [PMID: 33216125 DOI: 10.1093/trstmh/traa124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/09/2020] [Accepted: 10/20/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To address the reasons for inappropriate use of antimicrobials, it is important to understand the knowledge, attitude and practices (KAP) of all pertinent stakeholders. This multicentric survey is aimed at understanding the KAP quotients of the community regarding antimicrobial use and antimicrobial resistance (AMR), as such information is lacking in India. METHODS A cross-sectional survey was conducted by face-to-face interviews across five centers in India using a validated, field-tested questionnaire incorporating KAP domain questions. Scores were appropriately assigned to the questions. RESULTS The mean (SD) age of the respondents was 35.2 (12.61) y and 62% had a graduate or higher level of education. The median (IQR) KAP scores were 10 (8-12), 5 (3-5) and 2 (2-3) out of a maximum of 18, 5 and 6, respectively. Higher educational and socioeconomic levels were associated with better attitude scores, but knowledge levels were comparable. Correlations between KAP scores were poor. CONCLUSIONS This study reveals that laypeople have appropriate knowledge and attitude regarding antibiotic use and AMR to some degree but there are important lacunae and practices are often wanting. These issues need to be addressed in sustained public awareness and motivation campaigns to improve the rational use of antibiotics in India.
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Affiliation(s)
- Suparna Chatterjee
- Department of Pharmacology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Raja Chakraverty
- Department of Pharmacology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Nusrat Shafiq
- Department of Pharmacology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashish Pathak
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain, India
| | - Niyati Trivedi
- Department of Pharmacology, Government Medical College, Baroda, India
| | | | - Ashish Kumar Kakkar
- Department of Pharmacology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ratinder Jhaj
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - Rajni Kaul
- Indian Council of Medical Research, New Delhi, India
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44
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Trinh NTH, Cohen R, Lemaitre M, Chahwakilian P, Coulthard G, Bruckner TA, Milic D, Levy C, Chalumeau M, Cohen JF. Community antibiotic prescribing for children in France from 2015 to 2017: a cross-sectional national study. J Antimicrob Chemother 2021; 75:2344-2352. [PMID: 32449915 DOI: 10.1093/jac/dkaa162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To assess recent community antibiotic prescribing for French children and identify areas of potential improvement. METHODS We analysed 221 768 paediatric (<15 years) visits in a national sample of 680 French GPs and 70 community paediatricians (IQVIA's EPPM database), from March 2015 to February 2017, excluding well-child visits. We calculated antibiotic prescription rates per 100 visits, separately for GPs and paediatricians. For respiratory tract infections (RTIs), we described broad-spectrum antibiotic use and duration of treatment. We used Poisson regression to identify factors associated with antibiotic prescribing. RESULTS GPs prescribed more antibiotics than paediatricians [prescription rate 26.1 (95% CI 25.9-26.3) versus 21.6 (95% CI 21.0-22.2) per 100 visits, respectively; P < 0.0001]. RTIs accounted for more than 80% of antibiotic prescriptions, with presumed viral RTIs being responsible for 40.8% and 23.6% of all antibiotic prescriptions by GPs and paediatricians, respectively. For RTIs, antibiotic prescription rates per 100 visits were: otitis, 68.1 and 79.8; pharyngitis, 67.3 and 53.3; sinusitis, 67.9 and 77.3; pneumonia, 80.0 and 99.2; bronchitis, 65.2 and 47.3; common cold, 21.7 and 11.6; bronchiolitis 31.6 and 20.1; and other presumed viral RTIs, 24.1 and 11.0, for GPs and paediatricians, respectively. For RTIs, GPs prescribed more broad-spectrum antibiotics [49.8% (95% CI 49.3-50.3) versus 35.6% (95% CI 34.1-37.1), P < 0.0001] and antibiotic courses of similar duration (P = 0.21). After adjustment for diagnosis, antibiotic prescription rates were not associated with season and patient age, but were significantly higher among GPs aged ≥50 years. CONCLUSIONS Future antibiotic stewardship campaigns should target presumed viral RTIs, broad-spectrum antibiotic use and GPs aged ≥50 years.
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Affiliation(s)
- Nhung T H Trinh
- Université de Paris, Epidemiology and Statistics Research Center - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology research team, F-75004 Paris, France.,IQVIA, La Défense, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Saint-Maur-des-Fossés, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | | | | | | | - Tim A Bruckner
- Program in Public Health, University of California, Irvine, CA, USA
| | | | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Saint-Maur-des-Fossés, France.,Clinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Martin Chalumeau
- Université de Paris, Epidemiology and Statistics Research Center - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology research team, F-75004 Paris, France.,Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker - Enfants malades, Université de Paris, Paris, France
| | - Jérémie F Cohen
- Université de Paris, Epidemiology and Statistics Research Center - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology research team, F-75004 Paris, France.,Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker - Enfants malades, Université de Paris, Paris, France
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45
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Delory T, Jeanmougin P, Lariven S, Aubert JP, Peiffer-Smadja N, Boëlle PY, Bouvet E, Lescure FX, Le Bel J. A computerized decision support system (CDSS) for antibiotic prescription in primary care-Antibioclic: implementation, adoption and sustainable use in the era of extended antimicrobial resistance. J Antimicrob Chemother 2021; 75:2353-2362. [PMID: 32357226 DOI: 10.1093/jac/dkaa167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/03/2020] [Accepted: 03/31/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To describe the implementation and use of a computerized decision support system (CDSS) for antibiotic prescription in primary care in France (Antibioclic). The CDSS targets 37 infectious diseases and has been freely available on a website since 2011. METHODS Description and implementation of the architecture of a CDSS for antibiotic prescription in general practice. Analysis of the queries made between 2012 and 2018 on the CDSS by GPs. Analysis of two cross-sectional studies of users in 2014 and 2019. RESULTS The number of queries increased from a median of 796/day [IQR, 578-989] in 2012 to 11 125/day [5592-12 505] in 2018. Unique users increased from 414/day [245-494] in 2012 to 5365/day [2891-5769] in 2018. Time taken to make a query was 2 min [1.9-2.1]. Among 3 542 347 queries in 2018, 78% were for adults. Six situations accounted for ≥50% of queries: cystitis; acute otitis media; acute sinusitis; community-acquired pneumonia; sore throat; and pyelonephritis. Queries concerned pathologies for which antibiotic prescription was necessary (64%), was conditional on additional clinical steps (34%) or was not recommended (2%). Most users (81%) were GPs, with median age of 38 years [31-52] and 58% were female. Among the 4016 GPs who responded to the surveys, the vast majority (96%) reported using the CDSS during the consultation, with 24% systematically using Antibioclic to initiate an antibiotic course and 93% having followed the CDSS recommendation for the latest prescription. Most GPs were comfortable using the CDSS in front of a patient. CONCLUSIONS Antibioclic has been adopted and is widely used in primary care in France. Its interoperability could allow its adaptation and implementation in other countries.
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Affiliation(s)
- Tristan Delory
- Antibioclic steering committee, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F75012 Paris, France.,AP-HP, Bichat hospital, Department of Infectious and Tropical Diseases, Paris, France.,Hôpital Annecy-Genevois (CHANGE), Délégation à la Recherche Clinique et l'Innovation, 1 avenue de l'hôpital, 74370 Epagny-Metz-Tessy, France
| | - Pauline Jeanmougin
- Antibioclic steering committee, Paris, France.,Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Sylvie Lariven
- Antibioclic steering committee, Paris, France.,AP-HP, Bichat hospital, Department of Infectious and Tropical Diseases, Paris, France
| | | | - Nathan Peiffer-Smadja
- AP-HP, Bichat hospital, Department of Infectious and Tropical Diseases, Paris, France.,UMR 1137, INSERM, IAME, Paris, France.,Paris Diderot University Paris 7, Sorbonne Paris Cité, Paris, France
| | - Pierre-Yves Boëlle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F75012 Paris, France.,AP-HP, Saint Antoine hospital, Public Health unit, Paris, France
| | - Elisabeth Bouvet
- Antibioclic steering committee, Paris, France.,AP-HP, Bichat hospital, Department of Infectious and Tropical Diseases, Paris, France.,Paris Diderot University Paris 7, Sorbonne Paris Cité, Paris, France.,French National Authority for Health (HAS), Paris, France
| | - François-Xavier Lescure
- Antibioclic steering committee, Paris, France.,AP-HP, Bichat hospital, Department of Infectious and Tropical Diseases, Paris, France.,UMR 1137, INSERM, IAME, Paris, France.,Paris Diderot University Paris 7, Sorbonne Paris Cité, Paris, France
| | - Josselin Le Bel
- Antibioclic steering committee, Paris, France.,UMR 1137, INSERM, IAME, Paris, France.,Department of General Practice, Université Paris Diderot, Université de Paris, Sorbonne Paris Cité, 75018 Paris, France
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46
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Bulabula ANH, Dramowski A, Mehtar S. Antibiotic use in pregnancy: knowledge, attitudes and practices among pregnant women in Cape Town, South Africa. J Antimicrob Chemother 2021; 75:473-481. [PMID: 31637418 DOI: 10.1093/jac/dkz427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To establish the knowledge, attitudes and practices (KAP) regarding antibiotic use and self-medication among pregnant women. METHODS We conducted a KAP survey of 301 pregnant women hospitalized at a tertiary hospital obstetric service in Cape Town, South Africa in November and December 2017, using an interviewer-administered 12 item questionnaire. We stratified analysis of attitudes and practices by participants' mean knowledge score (K-score) group (<6 versus ≥6 out of 7 questions). Multivariate models were built to identify independent predictors of antibiotic self-medication and K-score. RESULTS The mean age of pregnant women was 29 (SD 6.1) years, 44/247 (17.8%) were nulliparous, 69/247 (27.9%) were HIV-infected, 228/247 (92.3%) had completed secondary school and 78/247 (31.6%) reported a monthly household income in the lowest category of ≤50-100 US dollars (USD). The mean K-score was 6.1 (SD 1.02) out of 7 questions. Sixteen percent of the cohort reported antibiotic self-medication, with higher rates among pregnant women with K-score <6 [18/48 (37.5%) versus 32/253 (12.6%); P<0.001]. The monthly household income category of >500 USD (the highest category) was the only predictor of antibiotic self-medication behaviour [adjusted OR=6.4 (95% CI 1.2-35.2), P=0.03]. CONCLUSIONS Higher antibiotic knowledge scores are associated with lower rates of antibiotic self-medication, whereas higher household income is correlated with increasing self-medication behaviours. Education of pregnant women regarding the potential dangers of antibiotic self-medication and stricter enforcement of existing South African antibiotic prescribing and dispensing regulations are needed.
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Affiliation(s)
- Andre N H Bulabula
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Infection Control Africa Network-ICAN, Cape Town, South Africa
| | - Angela Dramowski
- Infection Control Africa Network-ICAN, Cape Town, South Africa.,Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Shaheen Mehtar
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Infection Control Africa Network-ICAN, Cape Town, South Africa
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47
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Godman B, Egwuenu A, Haque M, Malande OO, Schellack N, Kumar S, Saleem Z, Sneddon J, Hoxha I, Islam S, Mwita J, do Nascimento RCRM, Dias Godói IP, Niba LL, Amu AA, Acolatse J, Incoom R, Sefah IA, Opanga S, Kurdi A, Chikowe I, Khuluza F, Kibuule D, Ogunleye OO, Olalekan A, Markovic-Pekovic V, Meyer JC, Alfadl A, Phuong TNT, Kalungia AC, Campbell S, Pisana A, Wale J, Seaton RA. Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries. Life (Basel) 2021; 11:life11060528. [PMID: 34200116 PMCID: PMC8229985 DOI: 10.3390/life11060528] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
- School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang 11800, Malaysia
- Correspondence: ; Tel.: +44-0141-548-3825; Fax: +44-0141-552-2562
| | - Abiodun Egwuenu
- AMR Programme Manager, Nigeria Centre for Disease Control (NCDC), Ebitu Ukiwe Street, Jabi, Abuja 240102, Nigeria;
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia;
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, P.O. Box 536, Egerton 20115, Kenya;
- East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda
| | - Natalie Schellack
- Faculty of Health Sciences, Basic Medical Sciences Building, University of Pretoria, Prinshof 349-Jr, Pretoria 0084, South Africa;
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India;
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan;
| | - Jacqueline Sneddon
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1005 Tirana, Albania;
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh;
| | - Julius Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0022, Gaborone, Botswana;
| | - Renata Cristina Rezende Macedo do Nascimento
- Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Ouro Preto 35400-000, Minas Gerais, Brazil;
| | - Isabella Piassi Dias Godói
- Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá 68500-00, Pará, Brazil;
- Center for Research in Management, Society and Epidemiology, Universidade do Estado de Minas Gerais, Belo Horizonte 31270-901, MT, Brazil
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda P.O Box 5175, Cameroon;
- Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H101, Eswatini;
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Israel Abebrese Sefah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana;
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya;
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
| | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek 13301, Namibia;
| | - Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria;
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos 100271, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos 100271, Nigeria;
- Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos 100271, Nigeria
| | - Vanda Markovic-Pekovic
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
| | - Abubakr Alfadl
- National Medicines and Poisons Board, Federal Ministry of Health, Khartoum 11111, Sudan;
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56264, Qassim 56453, Saudi Arabia
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, Vietnam;
| | - Aubrey C. Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 32379, Lusaka 10101, Zambia;
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK;
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Janney Wale
- Independent Researcher, 11a Lydia Street, Brunswick, VIC 3056, Australia;
| | - R. Andrew Seaton
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
- Infectious Disease Department, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
- Department of Medicine, University of Glasgow, Glasgow G12 8QQ, UK
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48
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The General Population's Inappropriate Behaviors and Misunderstanding of Antibiotic Use in China: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:antibiotics10050497. [PMID: 33925971 PMCID: PMC8146421 DOI: 10.3390/antibiotics10050497] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 12/27/2022] Open
Abstract
The general population has increasingly become the key contributor to irrational antibiotic use in China, which fuels the emergence of antibiotic resistance. This study aimed to estimate the prevalence of the general population’s irrational use behaviors of antibiotics and identify the potential reasons behind them. A systematic review and meta-analysis were performed concerning four main behaviors relevant to easy access and irrational use of antibiotics and common misunderstandings among the population about antibiotics. Four databases were searched, and studies published before 28 February 2021 were retrieved. Medium and high-level quality studies were included. Random effects meta-analysis was performed to calculate the prevalence of the general population’s irrational behaviors and misunderstandings relevant to antibiotic use. A total of 8468 studies were retrieved and 78 met the criteria and were included. The synthesis showed the public can easily obtain unnecessary antibiotics, with an estimated 37% (95% CI: 29–46) of the population demanding antibiotics from physicians and 47% (95% CI: 38–57) purchasing non-prescription antibiotics from pharmacies. This situation is severe in the western area of China. People also commonly inappropriately use antibiotics by not following antibiotic prescriptions (pooled estimate: 48%, 95% CI: 41–55) and preventatively use antibiotics for non-indicated diseases (pooled estimate: 35%, 95% CI: 29–42). Misunderstanding of antibiotic use was also popular among people, including incorrect antibiotic recognition, wrong antibiotic use indication, inappropriate usage, and ignorance of potential adverse outcomes. Over-and inappropriate use of antibiotics is evident in China and a multifaceted antibiotic strategy targeted at the general population is urgently required.
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49
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Chan AHY, Horne R, Lycett H, Raebel E, Guitart J, Wildman E, Ang K. Changing Patient and Public Beliefs About Antimicrobials and Antimicrobial Resistance (AMR) Using a Brief Digital Intervention. Front Pharmacol 2021; 12:608971. [PMID: 33867978 PMCID: PMC8045782 DOI: 10.3389/fphar.2021.608971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/03/2021] [Indexed: 11/15/2022] Open
Abstract
Background: A key driver of antimicrobial resistance (AMR) is patient demand for unnecessary antibiotics, which is driven by patients’ beliefs about antibiotics and AMR. Few interventions have targeted beliefs to reduce inappropriate demand. Objective: To examine whether a brief, online algorithm-based intervention can change beliefs that may lead to inappropriate antibiotic demand (i.e. perceptions of antibiotic necessity and lack of concern about antibiotic harm). Design: Pre- and post-intervention study. Participants: Participants were 18 years or older, and residing in the United Kingdom, who self-selected to participate via Amazon mTurk, an online survey plaform, and via research networks. Intervention: Participants were presented with a hypothetical situation of cold and flu symptoms, then exposed to the intervention. The online intervention comprised: 1) a profiling tool identifying individual beliefs (antibiotic necessity, concerns, and knowledge) driving inappropriate antibiotic demand; 2) messages designed to change beliefs and knowledge (i.e. reduce antibiotic necessity, and increase antibiotic concerns and knowledge), and 3) an algorithm linking specific messages to specific beliefs and knowledge. Main measures: The profiling tool was repeated immediately after the intervention and compared with baseline scores to assess change in beliefs. A paired samples t-test was used to determine intervention effect. Key Results: A total of 100 respondents completed the study. A significant change in beliefs relating to inappropriate demand was observed after the intervention, with a reduction in beliefs about antibiotic necessity (t = 7.254; p < 0.0001), an increase in antibiotic concerns (t = −7.214; p < 0.0001), and increases in antibiotic and AMR knowledge (t = −4.651; p < 0.0001). Conclusion: This study is the first to demonstrate that patient beliefs about antibiotics and AMR associated with inappropriate demand can be changed by a brief, tailored online intervention. This has implications for the design of future interventions to reduce unnecessary antimicrobial use.
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Affiliation(s)
- Amy Hai Yan Chan
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, United Kingdom.,School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Rob Horne
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, United Kingdom
| | - Helen Lycett
- Spoonful of Sugar Ltd-a UCL-Business Company, London, United Kingdom
| | - Eva Raebel
- Spoonful of Sugar Ltd-a UCL-Business Company, London, United Kingdom
| | - Jordi Guitart
- Spoonful of Sugar Ltd-a UCL-Business Company, London, United Kingdom
| | - Emilie Wildman
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, United Kingdom.,Spoonful of Sugar Ltd-a UCL-Business Company, London, United Kingdom
| | - Karen Ang
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, United Kingdom.,School of Pharmacy, University of Auckland, Auckland, New Zealand.,Spoonful of Sugar Ltd-a UCL-Business Company, London, United Kingdom
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Saliba-Gustafsson EA, Nyberg A, Borg MA, Rosales-Klintz S, Stålsby Lundborg C. Barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections: A qualitative study with general practitioners in Malta. PLoS One 2021; 16:e0246782. [PMID: 33571265 PMCID: PMC7877739 DOI: 10.1371/journal.pone.0246782] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a leading global public health concern and antibiotic use is a key driver. Effective interventions are needed to target key stakeholders, including general practitioners (GPs). In Malta, little is known about factors that influence GPs' antibiotic prescribing, making it challenging to implement targeted interventions. We therefore aimed to explore GPs' understanding of antibiotic use and resistance, and describe their perceived barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections in Malta. METHODS Face-to-face individual semi-structured interviews were held with a quota sample of 20 GPs in 2014. Interviews were audio recorded and transcribed verbatim, and later analysed iteratively using manifest and latent content analysis. Findings were collated in a socioecological model to depict how GPs as individuals are embedded within larger social systems and contexts, and how each component within this system impacts their prescribing behaviour. FINDINGS We found that GPs' antibiotic prescribing decisions are complex and impacted by numerous barriers and facilitators at the individual, interpersonal, organisational, community, and public policy level. Predominant factors found to impact GPs' antibiotic prescribing included not only intrinsic GP factors such as knowledge, awareness, experience, and misconceptions, but also several external factors. At the interpersonal level, GPs' perceived patient demand and behaviour to be a persistent issue that impacts their prescribing decisions. Similarly, some GPs found pressure from drug reps to be concerning despite being considered an important source of information. Organisational and public policy-level issues such as lack of access to relevant antibiotic prescribing guidelines and current antibiotic resistance data from the community, were also considered major barriers to appropriate antibiotic prescribing. Utilisation of diagnostic testing was found to be low and GPs' perceptions on the introduction of rapid point-of-care tests to support antibiotic prescription decisions, were mixed. CONCLUSION This study revealed the complexity of the antibiotic prescribing decision and the numerous barriers and facilitators that impact it, visualised through a socioecological model. Addressing GPs' antibiotic prescribing practices will require targeted and coordinated implementation activities at all levels to change behaviour and address misconceptions, whilst also improving the physical and social environment. TRIAL REGISTRATION NUMBER NCT03218930; https://clinicaltrials.gov/ct2/show/NCT03218930.
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Affiliation(s)
- Erika A. Saliba-Gustafsson
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Anna Nyberg
- Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Michael A. Borg
- Department of Infection Prevention and Control, Mater Dei Hospital, Msida, Malta
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Senia Rosales-Klintz
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
- Unit of Surveillance and Response Support (SRS), European Centre for Disease Prevention and Control, Solna, Sweden
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
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