A Multinational European Study of Patient Preferences for Novel Diagnostics to Manage Antimicrobial Resistance

Abstract Background Novel diagnostics are needed to manage antimicrobial resistance (AMR). Patient preferences are important in determining whether diagnostic tests are successful in practice, but there are few data describing the test attributes which matter most to patients. We elicited patients’ preferences for attributes of diagnostic tests that could be used to reduce unnecessary antibiotic use in primary care across seven European countries. Methods We used an online stated preference survey, including a discrete choice experiment (DCE). The DCE explored how patients make trade-offs between three key attributes of diagnostic tests: the speed that results were available, confidence in the test results, and how convenient it is to take the test. Individuals were eligible to complete the survey if they had taken antibiotics within the last 2 years and were resident in Germany, Italy, Spain, France, Greece, the Netherlands or the United Kingdom (UK). Results In total, 988 respondents completed the survey. The DCE responses illustrated that speed was the least important attribute in most countries. Responses from Germany and the Netherlands indicated that confidence was most important in these countries. Responses from the UK, France, Spain and Italy showed convenience as the most important attribute in these countries. Two attributes, confidence and convenience, were jointly favoured by respondents in Greece. Conclusion Patients in different European countries do not have the same preferences for the attributes of diagnostic tests to manage AMR in primary care. Failure to account for such differences during test development could reduce test uptake, result in continued overuse of antibiotics, and hamper marketisation.

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Diagnostic Tests Can Stem the Threat of Antimicrobial Resistance: Infectious Disease Professionals Can Help

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1527 ◽

2020 ◽

Author(s):

Dana Trevas ◽

Angela M Caliendo ◽

Kimberly Hanson ◽

Jaclyn Levy ◽

Christine C Ginocchio

Keyword(s):

Infectious Disease ◽

Antimicrobial Resistance ◽

Diagnostic Tests ◽

Healthcare Providers ◽

Federal Funding ◽

Antibiotic Use ◽

Advisory Council ◽

Resistant Bacteria ◽

Research Development ◽

Antibiotic Resistant

Abstract Uptake of existing diagnostics to identify infections more accurately could minimize unnecessary antibiotic use and decrease the growing threat of antibiotic resistance. The Infectious Diseases Society of America (IDSA) and the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) agree that, to improve uptake of existing diagnostics, healthcare providers, health systems, and payors all need better clinical and economic outcomes data to support use of diagnostic tests over empiric use of antibiotics, providers need better tools and education about diagnostic tests, and diagnostics developers need federal funding in the absence of a viable diagnostics market. Recommendations from PACCARB and the IDSA are amplified. Incentives for—and challenges to—diagnostics research, development, and uptake are summarized. Advocacy opportunities are given for infectious disease professionals to join the fight against antimicrobial resistance.

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Patient Preferences to Assess Value IN Gene Therapies: Protocol Development for the PAVING Study in Hemophilia

Frontiers in Medicine ◽

10.3389/fmed.2021.595797 ◽

2021 ◽

Vol 8 ◽

Author(s):

Eline van Overbeeke ◽

Brett Hauber ◽

Sissel Michelsen ◽

Michel Goldman ◽

Steven Simoens ◽

...

Keyword(s):

Patient Preferences ◽

Information Needs ◽

Stated Preference ◽

Health Gain ◽

Standard Of Care ◽

Gene Therapies ◽

Protocol Development ◽

Trade Offs ◽

Study Results ◽

Innovative Therapies

Introduction: Gene therapies are innovative therapies that are increasingly being developed. However, health technology assessment (HTA) and payer decision making on these therapies is impeded by uncertainties, especially regarding long-term outcomes. Through measuring patient preferences regarding gene therapies, the importance of unique elements that go beyond health gain can be quantified and inform value assessments. We designed a study, namely the Patient preferences to Assess Value IN Gene therapies (PAVING) study, that can inform HTA and payers by investigating trade-offs that adult Belgian hemophilia A and B patients are willing to make when asked to choose between a standard of care and gene therapy.Methods and Analysis: An eight-step approach was taken to establish the protocol for this study: (1) stated preference method selection, (2) initial attributes identification, (3) stakeholder (HTA and payer) needs identification, (4) patient relevant attributes and information needs identification, (5) level identification and choice task construction, (6) educational tool design, (7) survey integration, and (8) piloting and pretesting. In the end, a threshold technique survey was designed using the attributes “Annual bleeding rate,” “Chance to stop prophylaxis,” “Time that side effects have been studied,” and “Quality of Life.”Ethics and Dissemination: The Medical Ethics Committee of UZ KU Leuven/Research approved the study. Results from the study will be presented to stakeholders and patients at conferences and in peer-reviewed journals. We hope that results from the PAVING study can inform decision makers on the acceptability of uncertainties and the value of gene therapies to patients.

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Perceptions, Current Practices and Interventions of Community Pharmacists Regarding Antimicrobial Stewardship: A Qualitative Study in France

10.21203/rs.3.rs-1033731/v1 ◽

2021 ◽

Author(s):

Claire Durand ◽

Aude Chappuis ◽

Eric Douriez ◽

Frédérique Poulain ◽

Raheelah Ahmad ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Antimicrobial Resistance ◽

Community Health ◽

Antimicrobial Stewardship ◽

Thematic Analysis ◽

Community Pharmacists ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Community Health Care

Abstract Background: Community health care accounts for the vast majority of antibiotic use in Europe. Given the threat of antimicrobial resistance (AMR), there is an urgent need to develop new antimicrobial stewardship (AMS) interventions in primary care that could involve different health care providers including community pharmacists. This study aimed to explore the perceptions, currents practices and interventions of community pharmacists regarding antimicrobial stewardship.Methods: Semi-structured qualitative interviews were conducted with community pharmacists in France. Participants were recruited through a professional organization of community pharmacists combined with a snowballing technique. Interviews were audio recorded, transcribed and analyzed using thematic analysis. The Consolidated Framework for Implementation Research was used while developing the interview guide and carrying out thematic analysis.Results: Sixteen community pharmacists participated. All the respondents had good awareness about antimicrobial resistance and believed community pharmacists had an important role in tackling AMR. Some barriers to community pharmacists’ participation in AMS were identified such as difficult interactions with prescribers, lack of time and lack of access to patient medical records and diagnosis. Increased patient education, audits and feedback of antibiotic prescribing, increased point-of-care testing and delayed prescribing were interventions suggested by the pharmacists to improve antibiotic use in primary care. Strategies cited by participants to facilitate the implementation of such interventions are increased pharmacist-general practitioner collaboration, specialized training, clinical decision support tools as well as financial incentives. Conclusions: This study suggests that community pharmacists could play a greater role in infection management and AMS interventions. Further interprofessional collaboration is needed to optimize antibiotic prescribing and utilization in community health care.

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Risks of use and non-use of antibiotics in primary care: qualitative study of prescribers’ views

BMJ Open ◽

10.1136/bmjopen-2020-038851 ◽

2020 ◽

Vol 10 (10) ◽

pp. e038851

Author(s):

Olga Boiko ◽

Caroline Burgess ◽

Robin Fox ◽

Mark Ashworth ◽

Martin C Gulliford

Keyword(s):

Risk Assessment ◽

Primary Care ◽

Qualitative Study ◽

Management Strategies ◽

Inappropriate Prescribing ◽

Antibiotic Use ◽

Warning Signs ◽

Antibiotic Prescribing ◽

Trade Offs ◽

Perceive Risk

PurposeThe emergence of antimicrobial resistance has led to increasing efforts to reduce unnecessary use of antibiotics in primary care, but potential hazards from bacterial infection continue to cause concern. This study investigated how primary care prescribers perceive risk and safety concerns associated with reduced antibiotic prescribing.MethodsQualitative study using semistructured interviews conducted with primary care prescribers from 10 general practices in an urban area and a shire town in England. A thematic analysis was conducted.ResultsThirty participants were recruited, including twenty-three general practitioners, five nurses and two pharmacists. Three main themes were identified: risk assessment, balancing treatment risks and negotiating decisions and risks. Respondents indicated that their decisions were grounded in clinical risk assessment, but this was informed by different approaches to antibiotic use, with most leaning towards reduced prescribing. Prescribers’ perceptions of risk included the consequences of both inappropriate prescribing and inappropriate withholding of antibiotics. Sepsis was viewed as the most concerning potential outcome of non-prescribing, leading to possible patient harm and potential litigation. Risks of antibiotic prescribing included antibiotic resistant and Clostridium difficile infections, as well as side effects, such as rashes, that might lead to possible mislabelling as antibiotic allergy. Prescribers elicited patient preferences for use or avoidance of antibiotics to inform management strategies, which included educational advice, advice on self-management including warning signs, use of delayed prescriptions and safety netting.ConclusionsAttitudes towards antibiotic prescribing are evolving, with reduced antibiotic prescribing now being approached more systematically. The safety trade-offs associated with either use or non-use of antibiotics present difficulties especially when prescribing decisions are inconsistent with patients’ expectations.

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Perspectives of Syrian Refugees on Antibiotic Use and Prescribing in Dutch Primary Care: A Qualitative Study

10.21203/rs.3.rs-56378/v1 ◽

2020 ◽

Author(s):

Rima Alkirawan ◽

Ramin Kawous ◽

Evert Bloemen ◽

Maria E.T.C. van den Muijsenbergh ◽

Simone Goosen ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Qualitative Study ◽

The Netherlands ◽

Health Care System ◽

Antibiotic Use ◽

Syrian Refugees ◽

Dutch Health ◽

Dutch Health Care ◽

Care System

Abstract Background: Antibiotic resistance is an international public health concern. Medical culture influences antibiotic use. Migrants, like Syrian refugees, are confronted with a different health care system in their new country and also with different culture regarding antibiotic prescription. The aim of this study is to get insight into the perspectives, knowledge and practices among Syrian refugees regarding antibiotic use and prescribing in Dutch primary care.Methods: A qualitative study using semi-structured interviews with 12 Syrian refugees living in the Netherlands was conducted. Results: participants stressed the easy access to antibiotics in Syria and reported storing antibiotics at home for emergencies. In the Netherlands, some of them still self-prescribed antibiotics while others adhered to the Dutch GP’s advice. Syrian refugees believed in having a weaker immunity compared to the Dutch inhabitants. For their young children, they adhered to the new health care system which resulted in not giving the children antibiotics without a prescription. Several complaints about the Dutch health care system were identified such as difficult access to the desired medication and lack of medical care for their complaints. Most respondents preferred the Syrian health care system.Conclusion: Syrian refugees experienced restricted access to antibiotics in Dutch primary care which was contrary to their experiences in Syria. As a reaction, they continued self-medicating with antibiotics. However, some of them adapted to the Dutch health care culture and accepted the alternative treatment proposal. For their children most participants adhered to the prescription policy of antibiotics in the Netherlands.

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Outpatient consumption of antibiotics is linked to antibiotic resistance in Europe: results from the European Surveillance of Antimicrobial Consumption

Weekly releases (1997–2007) ◽

10.2807/esw.10.08.02652-en ◽

2005 ◽

Vol 10 (8) ◽

Cited By ~ 1

Author(s):

A Johnson

Keyword(s):

European Union ◽

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Selective Pressure ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

European Countries ◽

Antimicrobial Consumption ◽

Antibiotic Resistant ◽

Resistant Strains

There is increasing recognition that antibiotic consumption provides a major selective pressure for the emergence and persistence of antibiotic-resistant strains of bacteria. In 2001, a European Union Council Recommendation stated that data should be gathered on antibiotic use and antimicrobial resistance in European countries

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International surveillance of antimicrobial resistance in Europe: now we also need to monitor antibiotic use

Eurosurveillance ◽

10.2807/esm.06.01.00225-en ◽

2001 ◽

Vol 6 (1) ◽

pp. 1-2 ◽

Cited By ~ 15

Author(s):

S L A M Bronzwaer ◽

U Buchholz ◽

J. L. Kool

Keyword(s):

Staphylococcus Aureus ◽

European Union ◽

Antimicrobial Resistance ◽

Hospital Stay ◽

Methicillin Resistant Staphylococcus Aureus ◽

Antibiotic Use ◽

European Countries ◽

The European Union ◽

Prolonged Hospital Stay ◽

Prolonged Hospital

With travel and trade within the European Union (EU) increasing over the years, the risk of dissemination of (resistant) pathogens grows. Many studies have shown that there is a growing problem with antimicrobial resistance. For example, methicillin resistant Staphylococcus aureus (MRSA) was initially largely a problem of hospitals, but it is now increasingly reported as a community acquired infection. Certain strains have been shown to spread between European countries. Antimicrobial resistance may result in prolonged hospital stay, higher costs, and higher morbidity or even mortality.

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Outcome selection in primary care antimicrobial stewardship research

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkab347 ◽

2021 ◽

Author(s):

Ildikó Gágyor ◽

Alastair D Hay

Keyword(s):

Primary Care ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Patient Involvement ◽

Antibiotic Use ◽

Future Research ◽

Persistent Symptoms ◽

Wide Range ◽

Research Designs ◽

Outcome Selection

Abstract Clinical and antimicrobial stewardship (AMS) outcomes are highly relevant to pragmatic primary care trials, reflecting aspects, such as persistent symptoms and relapses, or antibiotic use and antimicrobial resistance. Sometimes both can be equally important. We present evidence demonstrating the wide range of outcome measures used in previous primary care trials and observe that there are no agreed standards for their design. We describe AMS interventions and outcomes in terms of intervention types and targets, and we make recommendations for future research designs. Specifically, we argue that: (i) where co-primary outcomes are considered appropriate, investigators should pre-specify interpretation of conflicting results; (ii) intervention evaluation should ensure prescriptions from sources outside of the usual provider are included in any AMS effectiveness measure; (iii) where possible, outcomes should include antimicrobial resistance; (iv) in some contexts, it may be necessary to include the antibiotics used within the intervention as part of the outcome; and (v) patient involvement is needed to establish the principles investigators should use when deciding whether the AMS or clinical outcomes should be prioritized.

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