Antibiotic Use and Resistance Public Understanding and ...
Antibiotic Use and Resistance Public Understanding and Expectations Facilitated learning session Session Aim To support prescribers to understand and manage patient expectations, reducing unnecessary antibiotic consumption Objectives Understand what the evidence tells us about patient understanding and expectations in relation to antibiotics Identify changes to practice that help reduce unnecessary consultations and antibiotic prescribing Improve - Identify areas for improvement and formulate an action plan
What is your experience? 1.Have you ever felt you prescribed an antibiotic when it wasnt clinically indicated? 2.Why do you think this was? How do you compare? Have a look at your prescribing data compared to you peers Variability in total volume of prescribing amongst GP practices in NHS Scotland Source: Information Services Division (ISD) What do you think people know?
Question time What % of patients in the UK know that 1. 2. 3. 4. Antibiotic dont kill viruses? Antibiotics dont treat cold and flu? Unnecessary use makes them become ineffective? Taking antibiotics often has side-effects? Monnet DL et al. Comment on: A systematic review of the publics knowledge and beliefs about antibiotic resistance. J Antimicrob Chemother published May 26, 2016 http://jac.oxfordjournals.org/content/early/2016/05/25/jac.dkw141.full.pdf
What else does the evidence tell us people think about resistance? They are at low risk from antibiotic resistance The development of resistance is due to the action of others That strategies to minimise risk should be directed at clinicians That resistance relates to changes in the human body (median 88%) That resistance is caused by excessive antibiotic use (median 70%) and not completing antibiotic courses (median 62%)
That reducing antibiotic use and discussing antibiotic resistance with their clinician were strategies to reduce resistance (84%) McCullogh AR et al. A systematic review of the publics knowledge and beliefs about antibiotic resistance. J Antimicrob Chemother 2016; 71: 27-33 http://jac.oxfordjournals.org/content/ early/2015/10/10/jac.dkv310.full What do people do when unwell? Face to face survey of 1,767 patients in England 2011 58% had respiratory tract infection last 6mths Action taken by public Percentage OTC/ alternative medicines
60% Rested 37% Contacted/ Visited GP 20% Pharmacy Advice 6% NHS Direct
1.4% Left over Antibiotics 0.4% NHS walk in centre 0% McNulty, Nichols, French, Joshi & Butler. British Journal of General Practice, 2013 e429 Why do they visit GP & what do they expect? Reasons given by public
Percentage Symptoms severe 51% Symptoms not improved after several days 47% Family or friends suggestion 14%
Other health problem 11% I usually visit GP with these symptoms 9% Worried will infect others who may get very ill 5% Expected Outcome Percentage
Antibiotics 53% Advice about self-carecare 24% Information about illness duration 7% Referral to hospital specialist
3% McNulty, Nichols, French, Joshi & Butler. British Journal of General Practice, 2013 e429 Expectations the reality Health care professionals over-estimate patient demand for antibiotics In patients with bronchitis, antibiotic prescribing had no effect on patient satisfaction scores Whereas careful physical examination did V Duijn et al. Illness behaviour and antibiotic prescription in patients with respiratory tract symptoms. Br J Gen Pract. 2007 July 1; 57(540): 561568. Patient Satisfaction
88% said they would trust their doctors advice on whether they needed an antibiotic or not (2014 survey 1,625 public)1 90% would use GP as trusted source of information on antibiotic info (2013 survey 1,314 public)2 GP QOF Patient Survey (2012 survey 983k responses) antibiotic prescribing volumes positive predictor for patient satisfaction with Dr and patient3 other research with more robust methodology, however, has not shown that reducing antibiotics has any negative impact on patient satisfaction highlights the importance of taking the time to educate and explain why they dont need an antibiotic 1. McNulty, Butler, et al Ipsos Mori 2014 2. Euro barometer Survey 2010 http://ec.europa.eu/health/antimicrobial_resistance/docs/ebs_338_en.pdf 3. Ashworth M et al. Antibiotic prescribing and patient satisfaction in primary care in England: cross-sectional analysis of national patient survey data and prescribing data. British Journal of General Practice. January 2016:e40-46 http://bjgp.org/content/bjgp/66/642/e40.full.pdf
What about parents/carers? Watch the short 4 minute animation What parents want from a GP consultation for their childs cough or respiratory tract infection http://www.bristol.ac.uk/primaryhealthcare/researchthemes/target/resources/ Patient Centred Consultations and Infection Management Pause for discussion Reflecting on your own practice and what you have heard what would you change about your consultations?
Shared decision making Interventions* to promote shared decision making in consultations for acute respiratory infections (ARIs) Reduced antibiotic use from 47% to 29% Did NOT increase patient initiated consultations Did NOT decrease patient satisfaction *Interventions in the 9 trials (1100 Drs, 492k patients) included training doctors in communication skills (n=6) and training plus giving written patient information (n=3) Coxeter P et al. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database of Systematic Reviews. November 2015 What patient resources are available? Parent/Carer Leaflet: When Should I Worry Source: Cardiff University www.whenshouldiworry.com/resources/When%20should%20 I
%20worry-Booklet_Scotland.pdf Videos e.g. Health Education England Animation on AMR (1:49) www.youtube.com/watch ?v=oMnU6g2djm4 Treating Your infection leaflet http://www.rcgp.org.uk/ clinical-and-research/toolkits/~/link.aspx?_id=9FCF9DA4B4A045519593320478DFD9E7&_z=z Education programme/games for juniors/seniors and young adults www.e-bug.eu/
European Antibiotic Awareness Day Resources See SAPG website for current range of materials: www.scottishmedicines.org.uk/SAPG/ European_Antibiotic_Awareness_Day/European_Antibiotic_Awareness_Day Summary - Key Practice Points Listen to patients ideas, concerns and expectations Try not to make assumptions Educate the patient to enable you to reach a shared decision Most patients trust you Encourage self-management/utilisation of pharmacies for advice Utilise resources such as patient information leaflets to support the information you give (including safety netting)
Next Steps What could we do better? What do we need to do next, who will do it and by when? How could we evaluate the impact of any changes? Practical Tips Visit QI Hub for advice on action planning Refer to ScRAP Support Pack for examples of improvements and measures
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