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Boukpessi TB, Kpanake L, Gagnier JP. Why are African immigrants in Montreal reluctant to use mental health services?: a systematic inventory of reasons. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02566-1. [PMID: 37805584 DOI: 10.1007/s00127-023-02566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/28/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Previous research has shown that non-Caucasian immigrants in Western countries are less likely than native-born people to use mental health services. This study examined the reasons underlying reluctance to use mental health services among African immigrants in Montreal, Canada. METHODS The study participants were 280 African immigrants who had experienced symptoms suggesting depression but did not use formal mental health services. They were presented with a questionnaire that contained 65 statements referring to reasons for not using formal mental health services while experiencing those symptoms and were asked to indicate their degree of agreement with each of the statements on a scale of 0-10. Responses were then analyzed using factor analysis. RESULTS An eight-factor structure of reasons was found: "Minimizing symptoms and perceived self-efficacy" (61% of the sample), "Relying on spiritual care" (56% of the sample), "Cost and waiting time" (45% of the sample), "Influence of significant others" (34% of the sample), "Lack of cultural competence" (32% of the sample), "Fear of stigmatization" (23% of the sample), "Nature of the consultation" (10% of the sample) and "Social models" (8% of the sample). Scores on these factors were related to participants' demographics. CONCLUSION Effectively addressing the underutilization of mental health services among African immigrants requires a multifaceted approach rather than one focused on a single barrier. Our findings suggest critical points that could help develop tailored interventions to address the various barriers to care.
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Essack S, Bell J, Burgoyne D, Eljaaly K, Tongrod W, Markham T, Shephard A, López-Pintor E. Addressing Consumer Misconceptions on Antibiotic Use and Resistance in the Context of Sore Throat: Learnings from Social Media Listening. Antibiotics (Basel) 2023; 12:957. [PMID: 37370276 DOI: 10.3390/antibiotics12060957] [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: 03/08/2023] [Revised: 05/11/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
A misunderstanding of the mechanism of action and bacterial targets of antibiotics by consumers may drive inappropriate antibiotic use and antimicrobial resistance (AMR). Tackling AMR requires an in-depth understanding of consumer beliefs and misconceptions. We explored consumer conversations on a number of social media platforms on antibiotic use and AMR in the context of sore throat and how coronavirus disease 2019 (COVID-19) affected online conversations between 1 January 2018 and 25 November 2021 across eight countries. Five distinct consumer groups were identified (antibiotic-preserving peer educators, antibiotic-cautious consumers, medication-resistant antibiotic opponents, believers in the strength of antibiotics, determined pro-antibiotic consumers) with a wide spectrum of beliefs around antibiotics in sore throat. Many opinions were based upon misconceptions, the most prominent of which was that antibiotics are strong medications that can treat all types of sore throat. COVID-19 had a multifaceted effect on the sore throat and AMR conversation. Sore throat triggered anxiety as consumers feared it may be a COVID-19 symptom while engagement in conversations around antibiotics for COVID-19 increased. Finally, consumers sought multiple routes to access antibiotics, such as directly from the pharmacy or by attempting to persuade physicians to prescribe. Knowledge obtained from this study could be used to develop focused approaches to dispel consumer misconceptions and mitigate AMR.
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Affiliation(s)
- Sabiha Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - John Bell
- Graduate School of Health, University of Technology, Sydney, NSW 2007, Australia
| | - Douglas Burgoyne
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Khalid Eljaaly
- Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Wirat Tongrod
- Faculty of Pharmaceutical Sciences, Huachiew Chalermprakiet University, Samut Prakan 10540, Thailand
| | | | - Adrian Shephard
- Reckitt Benckiser Healthcare International Ltd., Slough SL1 3UH, Berkshire, UK
| | - Elsa López-Pintor
- Department of Engineering, Area of Pharmacy and Pharmaceutical Technology, Miguel Hernández University of Elche, 03550 Alicante, Spain
- CIBER in Epidemiology and Public Health, 28029 Madrid, Spain
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Zhou Y, Acevedo Callejas ML, Li Y, MacGeorge EL. What Does Patient-Centered Communication Look Like?: Linguistic Markers of Provider Compassionate Care and Shared Decision-Making and Their Impacts on Patient Outcomes. HEALTH COMMUNICATION 2023; 38:1003-1013. [PMID: 34657522 DOI: 10.1080/10410236.2021.1989139] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Patient-centered communication promotes positive patient outcomes. This study examines the linguistic markers of two key dimensions of patient-centered communication (i.e., provider compassionate care and shared decision-making) and their mediating effects on patient perceived quality of and affective responses to the provider's treatment recommendations. Transcripts (N = 343) of provider talk from provider-patient interactions in medical visits for upper respiratory infection symptoms where patients were not prescribed with antibiotics were analyzed with the Linguistic Inquiry and Word Count (LIWC) dictionary. Results showed that providers' use of affiliation words positively predicted patients' perceptions of their providers' compassionate care. Providers' use of insight words negatively predicted patients' perceptions of provider shared decision-making. Meanwhile, providers' use of first-person singular pronouns, causation and differentiation words, and clout words were positively related to perceived provider shared decision-making. Patient perceived compassionate care and shared decision-making further increased patients' positive affect toward and perceived quality of non-antibiotic treatment recommendations. These perceptions also reduced their negative affect toward the recommendations. Implications of the findings are discussed with regard to patient-centered communication in relation to the promotion of antibiotic stewardship.
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Affiliation(s)
- Yanmengqian Zhou
- Department of Communication Arts & Sciences, State College, Pennsylvania State University
| | | | - Yuwei Li
- Department of Communication Arts & Sciences, State College, Pennsylvania State University
| | - Erina L MacGeorge
- Department of Communication Arts & Sciences, State College, Pennsylvania State University
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4
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Acevedo Callejas ML, Zhou Y, Farrell EL, Foley KA. Providers' shared decision-making as a predictor of healthcare outcomes for college-aged adults managing upper respiratory tract infections. PATIENT EDUCATION AND COUNSELING 2023; 108:107619. [PMID: 36603471 DOI: 10.1016/j.pec.2022.107619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/08/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Strategies that assist patients with upper respiratory tract infections (URTIs) to endorse non-antibiotic treatments are vital to curbing antibiotic resistance. This study examines the potential of shared decision-making (SDM) for improving stewardship-relevant outcomes and investigates patient affect as a mechanism that explains the beneficial impact of perceived SDM. METHOD Patients (N = 433) seeking care for URTIs at a university student health center and not prescribed antibiotics completed a pre-visit questionnaire and two surveys one day and 14 days post-visit. The day-one survey assessed perceived SDM, affect, and immediate stewardship-relevant outcomes, and the day-14 survey assessed long-term stewardship-relevant outcomes. RESULTS Perceived SDM was negatively associated with negative affect and positively associated with positive affect, favorable perceptions of non-antibiotic treatments and providers, and self-efficacy to manage symptoms and obtain follow-up care. Patient affect and day-one outcomes were mediators between perceived SDM and retrospective self-efficacy two weeks post-visit. CONCLUSION The study illustrated the beneficial influence of patient perceived SDM on antibiotic stewardship in both short and long terms and elucidated the mechanisms through which the influence occurs. PRACTICE IMPLICATIONS SDM can be an effective strategy for primary care providers to improve patients' outcomes with URTI visits without prescribing unwarranted antibiotics.
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Affiliation(s)
| | - Yanmengqian Zhou
- Department of Communication Studies, Louisiana State University, Baton Rouge, USA.
| | - Erina L Farrell
- Department of Communication Arts & Sciences, Pennsylvania State University, University Park, USA
| | - Kasey A Foley
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, USA
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5
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Böhm R, Holtmann-Klenner C, Korn L, Santana AP, Betsch C. Behavioral determinants of antibiotic resistance: The role of social information. Appl Psychol Health Well Being 2022; 14:757-775. [PMID: 35103398 PMCID: PMC9544926 DOI: 10.1111/aphw.12345] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/19/2022] [Indexed: 12/01/2022]
Abstract
The increasing development of resistant pathogens is one of the greatest global health challenges. As antibiotic overuse amplifies antibiotic resistance, antibiotic intake poses a social dilemma in which individuals need to decide whether to prosocially reduce their intake in the collective interest versus to (over)use it even in case of mild diseases. We devise a novel behavioral game paradigm to model the social dilemma of antibiotic intake. Using this new method in an incentivized laboratory experiment (N = 272 German participants), we varied whether players had mutual knowledge about their antibiotic intake. The results indicate that there was substantial antibiotic overuse in the absence of social information. Overuse decreased when social information was present. Our postexperimental survey data further suggest that social information impacts people's behavioral motivation, evaluation of the other player, and positive affect. Taken together, providing social information about people's antibiotic intake may help in reducing antibiotic overuse. On a more general level, the novel behavioral game may be adapted to study other aspects of antibiotic intake to promote prudent use of antibiotics.
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Affiliation(s)
- Robert Böhm
- Faculty of Psychology, University of Vienna, Vienna, Austria.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark
| | - Cindy Holtmann-Klenner
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany
| | - Lars Korn
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany.,Media and Communication Science, University of Erfurt, Erfurt, Germany.,Health Communication, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Ana Paula Santana
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany.,Media and Communication Science, University of Erfurt, Erfurt, Germany.,Health Communication, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
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6
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Kalam MA, Shano S, Afrose S, Uddin MN, Rahman N, Jalal FA, Akter S, Islam A, Anam MM, Hassan MM. Antibiotics in the Community During the COVID-19 Pandemic: A Qualitative Study to Understand Users' Perspectives of Antibiotic Seeking and Consumption Behaviors in Bangladesh. Patient Prefer Adherence 2022; 16:217-233. [PMID: 35115769 PMCID: PMC8806049 DOI: 10.2147/ppa.s345646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/12/2022] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic is thought to have led to increased "inappropriate" or "unjustified" seeking and consumption of antibiotics by individuals in the community. However, little reference has been made to antibiotic seeking and using behaviors from the perspectives of users in Bangladesh during this health crisis. PURPOSE This study seeks to document how antibiotic medicines are sought and used during a complex health crisis, and, within different contexts, what are the nuanced reasons why patients may utilize these medicines sub-optimally. METHODS We used an exploratory, qualitative design. Forty semi-structured telephone interviews were conducted with people diagnosed with COVID-19 (n=20), who had symptoms suggestive of COVID-19 (n=20), and who had received care at home in two cities between May and June 2021 in Bangladesh. In this study, an inductive thematic analysis was performed. RESULTS The analysis highlighted the interlinked relationships of antibiotic seeking and consumption behaviors with the diversity of information disseminated during a health crisis. Antibiotic-seeking behaviors are related to previous experience of use, perceived severity of illness, perceived vulnerability, risk of infection, management of an "unknown" illness and anxiety, distrust of expert advice, and intrinsic agency on antimicrobial resistance (AMR). Suboptimal adherence, such as modifying treatment regimes and using medication prescribed for others, were found to be part of care strategies used when proven therapeutics were unavailable to treat COVID-19. Early cessation of therapy was found to be a rational practice to avoid side effects and unknown risks. CONCLUSION Based on the results, we highly recommend the take up of a pandemic specific antimicrobial stewardship (AMS) program in the community. To deliver better outcomes of AMS, incorporating users' perspectives could be a critical strategy. Therefore, a co-produced AMS intervention that is appropriate for a specific cultural context is an essential requirement to reduce the overuse of antibiotics during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Md Abul Kalam
- Bangladesh Country Office, Helen Keller International, Dhaka, 1212, Bangladesh
- Correspondence: Md Abul Kalam, Helen Keller International, Bangladesh Country Office, Dhaka, 1215, Bangladesh, Tel +8801912408148, Email
| | - Shahanaj Shano
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, 1212, Bangladesh
- EcoHealth Alliance, New York, NY, USA
| | | | - Md Nasir Uddin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, 1212, Bangladesh
| | - Nafis Rahman
- Department of Public Health, American International University of Bangladesh, Dhaka, 1212, Bangladesh
| | - Faruk Ahmed Jalal
- Handicap International - Humanity & Inclusion, Dhaka, 1212, Bangladesh
| | - Samira Akter
- Department of Anthropology, Jahangirnagar University, Savar, Dhaka, 1243, Bangladesh
| | - Ariful Islam
- EcoHealth Alliance, New York, NY, USA
- Centre for Integrative Ecology, School of Life and Environmental Science, Deakin University, Geelong Campus, Warrnambool, VIC, 3216, Australia
| | - Md Mujibul Anam
- Department of Anthropology, Jahangirnagar University, Savar, Dhaka, 1243, Bangladesh
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Vaismoradi M, Fredriksen Moe C, Vizcaya-Moreno F, Paal P. Ethical Tenets of PRN Medicines Management in Healthcare Settings: A Clinical Perspective. PHARMACY 2021; 9:174. [PMID: 34707079 PMCID: PMC8552074 DOI: 10.3390/pharmacy9040174] [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: 09/03/2021] [Revised: 10/16/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022] Open
Abstract
Prescription and administration of pro re nata (PRN) medications has remained a poorly discussed area of the international literature regarding ethical tenets influencing this type of medication practice. In this commentary, ethical tenets of PRN medicines management from the clinical perspective based on available international literature and published research have been discussed. Three categories were developed by the authors for summarising review findings as follows: 'benefiting the patient', 'making well-informed decision', and 'follow up assessment' as pre-intervention, through-intervention, and post-intervention aspects, respectively. PRN medicines management is mainly intertwined with the ethical tenets of beneficence, nonmaleficence, dignity, autonomy, justice, informed consent, and error disclosure. It is a dynamic process and needs close collaboration between healthcare professionals especially nurses and patients to prevent unethical practice.
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Affiliation(s)
- Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway;
| | | | - Flores Vizcaya-Moreno
- Department of Nursing, Faculty of Health Sciences, University of Alicante, 03080 Alicante, Spain;
| | - Piret Paal
- WHO Collaborating Centre, Institute of Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria;
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8
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Aizman L, Barbieri JS, Feit EM, Lukowiak TM, Perz AM, Shin TM, Miller CJ, Golda N, Leitenberger JJ, Carr DR, Nijhawan RI, Hasan A, Eisen DB, Etzkorn JR. Preferences for Prophylactic Oral Antibiotic Use in Dermatologic Surgery: A Multicenter Discrete Choice Experiment. Dermatol Surg 2021; 47:1214-1219. [PMID: 34081047 DOI: 10.1097/dss.0000000000003113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antibiotics are often prescribed after dermatologic surgery for infection prophylaxis, but patient preferences about prophylactic antibiotics are not well understood. OBJECTIVE To understand patient preferences about taking antibiotics to prevent surgical site infection (SSI) relative to antibiotic efficacy and antibiotic-associated adverse drug reactions. MATERIALS AND METHODS Multi-center, prospective discrete choice experiment (DCE). RESULTS Three hundred thirty-eight respondents completed the survey and DCE. 54.8% of respondents preferred to take an antibiotic if it reduced the SSI rate from 5% to 2.5% and if the risk of adverse drug reactions was low (1% risk gastrointestinal upset, 0.5% risk itchy skin rash, 0.01% risk emergency department visit). Even if an antibiotic could eliminate SSI risk (0% risk SSI) and had a low adverse drug reaction profile, 26.7% of respondents prefer not to take prophylactic oral antibiotics. CONCLUSION Risk-benefit thresholds for taking antibiotics to prevent SSI vary widely. Clinical trials are needed to better characterize the effectiveness and risks of oral antibiotic SSI prophylaxis to guide decision-making. Future studies should also evaluate whether shared decision-making can improve the patient experience.
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Affiliation(s)
- Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - John S Barbieri
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elea M Feit
- LeBow College of Business, Drexel University, Philadelphia, Pennsylvania
| | - Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri
| | - Justin J Leitenberger
- Department of Dermatology, Oregon Health and Science University School of Medicine, Portland, Oregon
| | - David R Carr
- Division of Dermatology, the Ohio State University Medical Center, Columbus, Ohio
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aliza Hasan
- Department of Dermatology, University of California-Davis, Sacramento, California
| | - Daniel B Eisen
- Department of Dermatology, University of California-Davis, Sacramento, California
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Gulliford MC, Charlton J, Boiko O, Winter JR, Rezel-Potts E, Sun X, Burgess C, McDermott L, Bunce C, Shearer J, Curcin V, Fox R, Hay AD, Little P, Moore MV, Ashworth M. Safety of reducing antibiotic prescribing in primary care: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background
The threat of antimicrobial resistance has led to intensified efforts to reduce antibiotic utilisation, but serious bacterial infections are increasing in frequency.
Objectives
To estimate the risks of serious bacterial infections in association with lower antibiotic prescribing and understand stakeholder views with respect to safe antibiotic reduction.
Design
Mixed-methods research was undertaken, including a qualitative interview study of patient and prescriber views that informed a cohort study and a decision-analytic model, using primary care electronic health records. These three work packages were used to design an application (app) for primary care prescribers.
Data sources
The Clinical Practice Research Datalink.
Setting
This took place in UK general practices.
Participants
A total of 706 general practices with 66.2 million person-years of follow-up from 2002 to 2017 and antibiotic utilisation evaluated for 671,830 registered patients. The qualitative study included 31 patients and 30 health-care professionals from primary care.
Main outcome measures
Sepsis and localised bacterial infections.
Results
Patients were concerned about antimicrobial resistance and the side effects, as well as the benefits, of antibiotic treatment. Prescribers viewed the onset of sepsis as the most concerning potential outcome of reduced antibiotic prescribing. More than 40% of antibiotic prescriptions in primary care had no coded indication recorded across both Vision® and EMIS® practice systems. Antibiotic prescribing rates varied widely between general practices, but there was no evidence that serious bacterial infections were less frequent at higher prescribing practices (adjusted rate ratio for 20% increase in prescribing 1.03, 95% confidence interval 1.00 to 1.06; p = 0.074). The probability of sepsis was lower if an antibiotic was prescribed at an infection consultation, and the number of antibiotic prescriptions required to prevent one episode of sepsis (i.e. the number needed to treat) decreased with age. For those aged 0–4 years, the number needed to treat was 29,773 (95% uncertainty interval 18,458 to 71,091) in boys and 27,014 (95% uncertainty interval 16,739 to 65,709) in girls. For those aged > 85 years, the number needed to treat was 262 (95% uncertainty interval 236 to 293) in men and 385 (95% uncertainty interval 352 to 421) in women. Frailty was associated with a greater risk of sepsis and a smaller number needed to treat. For severely frail patients aged 55–64 years, the number needed to treat was 247 (95% uncertainty interval 156 to 459) for men and 343 (95% uncertainty interval 234 to 556) for women. At all ages, the probability of sepsis was greatest for urinary tract infection, followed by skin infection and respiratory tract infection. The numbers needed to treat were generally smaller for the period 2014–17, when sepsis was diagnosed more frequently. The results are available using an app that we developed to provide primary care prescribers with stratified risk estimates during infection consultations.
Limitations
Analyses were based on non-randomised comparisons. Infection episodes and antibiotic prescribing are poorly documented in primary care.
Conclusions
Antibiotic treatment is generally associated with lower risks, but the most serious bacterial infections remain infrequent even without antibiotic treatment. This research identifies risk strata in which antibiotic prescribing can be more safely reduced.
Future work
The software developed from this research may be further developed and investigated for antimicrobial stewardship effect.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin C Gulliford
- School of Population Health and Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Judith Charlton
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Olga Boiko
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Joanne R Winter
- School of Population Health and Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Emma Rezel-Potts
- School of Population Health and Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Xiaohui Sun
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Caroline Burgess
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Lisa McDermott
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Catey Bunce
- School of Population Health and Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - James Shearer
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Vasa Curcin
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Robin Fox
- Bicester Health Centre, Bicester, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Michael V Moore
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King’s College London, London, UK
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10
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Voicu MN, Ahmet AM, Turcu-Stiolica M, Turcu-Stiolica A, Barbulescu AL, Popescu F. Antibiotic Resistance, Still a Global Challenge. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:284-289. [PMID: 34765250 PMCID: PMC8551888 DOI: 10.12865/chsj.47.02.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/22/2021] [Indexed: 11/15/2022]
Abstract
The use of antibiotics represents a major health problem worldwide because they are often administered without medical prescription. This has led to different situations starting from a large use in inappropriate cases without medical recommendation, to a major issue that represents antimicrobial resistance. Our aim was to identify the opinion of healthcare workers (physicians and pharmacists) about the most effective solution at reducing antimicrobial resistance, helping the policy makers to take a decision. The present study was conducted from March 15th, 2021 to April 15th, 2021, using a virtual questionnaire. A total of 397 respondents provided a complete response to our questionnaire: 313 physicians and 84 pharmacists. Our results provided valuable insights that can be used to inform the development of a national health policy, resulting in population health gains. Our work provided an indication of physicians' preferences toward solutions as "A tax on antibiotic consumption, which could be used to fund innovation strategies." (41.53%) and "An educational program for patients that highlights the causes and effects of antimicrobial resistance." (42.49%). The pharmacists preferred the solutions as "An educational program for patients that highlights the causes and effects of antimicrobial resistance." (52.38%) and "Elimination of antibiotics from the list of the emergency pharmaceutical services." (42.86%). A small number of physicians (2.24%) and pharmacists (3.57%) recommended as the most effective solution at reducing antimicrobial resistance "Restrain antibiotic use in the food industry."
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Affiliation(s)
- Mirela Nicoleta Voicu
- Phd Student, Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Romania
| | - Ana Maria Ahmet
- Student, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Florica Popescu
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Romania
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11
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Boiko O, Gulliford MC, Burgess C. Revisiting patient expectations and experiences of antibiotics in an era of antimicrobial resistance: Qualitative study. Health Expect 2020; 23:1250-1258. [PMID: 32666579 PMCID: PMC7696122 DOI: 10.1111/hex.13102] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/09/2020] [Accepted: 06/24/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate contemporary patient expectations and experiences of antibiotic prescribing in England. BACKGROUND Primary care providers' compliance with patient influences has been identified as a motivation for antibiotic-prescribing behaviour. Since 2013, there have been concerted efforts to publicize and address the growing threat of antimicrobial resistance. A fresh qualitative insight into patient expectations and experiences is needed. DESIGN Qualitative study using semi-structured interviews. SETTING AND PARTICIPANTS Two English regions, one an urban metropolitan area and the other a town in rural England. Patients who recently consulted for infections were recruited. The information power approach was used to determine the number of participants, yielding a sample of 31 participants. MAIN MEASURES Thematic analysis was carried out to analyse the interview data. RESULTS Five themes were identified: beliefs, expectations, experiences of taking antibiotic, experience of antimicrobial resistance and side-effects, and experiences of consultations. The accounts reflected improved public knowledge: antibiotics were perceived to be much-needed medicines that should be prescribed when appropriate. The data showed that patients formed expectations of expectations, trying to read the prescribers' intentions and reflect on the dependency between what prescribers and patients wanted. Patient experiences featured as nuanced and detailed with knowledge of AMR and side-effects of antibiotics in the context of positive consultation experiences. CONCLUSIONS The study highlighted complex interplays between adherence to antibiotics and consuming antibiotics in reflexive, informed ways. Ensuring that present and future patients are informed about potential benefits and harms of antibiotic use will contribute to future antimicrobial stewardship.
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Affiliation(s)
- Olga Boiko
- School of Population Health and Environmental SciencesKing’s College LondonLondonUK
| | - Martin C. Gulliford
- School of Population Health and Environmental SciencesKing’s College LondonLondonUK
- National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ National Health Service Foundation TrustLondonUK
| | - Caroline Burgess
- School of Population Health and Environmental SciencesKing’s College LondonLondonUK
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Cavitary Pneumonia: A Complication of Antibiotic Noncompliance. Case Rep Pulmonol 2020; 2020:5971348. [PMID: 32257494 PMCID: PMC7102419 DOI: 10.1155/2020/5971348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/07/2020] [Accepted: 02/17/2020] [Indexed: 01/15/2023] Open
Abstract
In this report, we present a complicated case of community-acquired pneumonia in a 5-year-old boy. The patient first presented to the pulmonology clinic with the diagnosis of asthma and a recent history of recurrent pneumonia. Poor compliance to two courses of outpatient oral antibiotics resulted in persistent pneumonia symptoms with unresolved radiographic findings warranting parenteral antibiotics. Despite 2 symptom-free weeks, the patient returned to the emergency department with recurrence of symptoms where imaging revealed a cavitary lesion requiring a prolonged course of parenteral antibiotics. This report further supports the detrimental impact of partially treated infections related to poor compliance to antibiotic regimens.
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