Evaluation of a multimodal intervention to promote rational antibiotic use in primary care

Background Increasing antimicrobial resistance is a serious societal challenge affecting outpatient, inpatient and veterinary care. The German One-Health project, RAI (Rational use of Antibiotics via Information and Communication) addresses all three sectors. In the outpatient sector, General Practitioners (GPs) are the main prescribers of antibiotics and were therefore, targeted for this study. A multimodal intervention focusing on Acute Respiratory Tract infections (ARI) was designed and implemented. The aim of this study was to evaluate acceptance, rating and the self-reported impact of the intervention among GPs. Methods The intervention offered six tools: a GP training on rational antibiotic use, an app for self-monitoring, a leaflet and a set of posters (both for use as information materials in waiting rooms) and both digital and printed information prescriptions (material for ‘prescribing’ information instead of an antibiotic to the patient). The tools could be used according to individual preferences. The intervention was conducted between August 2016 and July 2017. Following the intervention, a three pages anonymous questionnaire was sent to all 271 participants. Items covered socio-demographic and professional background, use and judgement of the intervention tools (6 point Likert scale), impact of the intervention tools (4 point Likert scale). Results The response rate was 39% (n = 107). On average, respondents used 3.1 of the six available tools, with printed information prescriptions used most frequently (79%). Digital information prescriptions were used more frequently by men than by women (OR 2.8; 95% CI 1.16–7.24; p = 0.02). Eighty-seven percent of respondents stated that information prescriptions supported doctor-patient communication. In a comparison of the overall impression of the different intervention tools the GP training on rational antibiotic use was rated best (1.67 on a 6 point scale with 1 = highest, 6 = lowest) and most often noted as having had a “strong” or “very strong” impact on personal antibiotic prescribing behavior. Conclusions The multimodal intervention addressing education and communication was well accepted among GPs and could help in fostering rational use of antibiotics in primary care.

Knowledge levels and awareness about rational antibiotic use and antimicrobial resistance before and after graduation: A cross-sectional study conducted in Malatya province, Turkey

Background Irrational use of antibiotics may adversely affect the treatment outcomes or even lead to increased antimicrobial resistance. We aimed to evaluate the level of theoretical knowledge of rational antibiotic use and awareness about antimicrobial resistance among the senior students at a medical school and the family physicians.Methods This study was cross-sectional research and was carried out between 01 February-30 April 2019 in Malatya province. Two-hundred twenty-five senior students in the Inonu University Medical School (Group 1) and 230 actively-working family physicians in Malatya primary healthcare services who were found eligible (Group 2). Power analysis was calculated as the minimum of 240 participants when considering a proportion difference of 0.18 between the groups, a type I error of 0.05 and a type II error of 0.20. A p<0.05 value was considered to be statistically significant.Results Researchers argued that penal sanctions can be more effective by developing strict use policies to raise awareness of resistance to antimicrobials. Group 2 had higher self-confidence, and it was also concluded that they forgot their theoretical antibiotic knowledge over time, and they could not follow the current information because of the intensity of their working life. Both groups stated that post-graduation training could be used effectively for reducing antimicrobial resistance.Conclusions This study attempted to increase awareness to determine the difference in theoretical knowledge levels and behavior models of physicians before and after graduation. Sustainable antibiotic training for doctors after graduation will contribute positive effects to antimicrobial resistance and rational use of antibiotics.

Knowledge levels and awareness about rational antibiotic use and antimicrobial resistance before and after graduation

Objective Irrational use of antibiotics may adversely affect the treatment outcomes or even lead to increased antimicrobial resistance. We aimed to evaluate the level of theoretical knowledge of rational antibiotic use and awareness about antimicrobial resistance among the senior students at a medical school and the family physicians.Methods This study was cross-sectional research and was carried out between 01 February-30 April 2019 in Malatya province. Two-hundred twenty-five senior students in the Inonu University Medical School (Group 1) and 230 actively-working family physicians in Malatya primary healthcare services who were found eligible (Group 2). Power analysis was calculated as the minimum of 240 participants when considering a proportion difference of 0.18 between the groups, a type I error of 0.05 and a type II error of 0.20. A p<0.05 value was considered to be statistically significant.Results Researchers argued that penal sanctions can be more effective by developing strict use policies to raise awareness of resistance to antimicrobials. Group 2 had higher self-confidence, and it was also concluded that they forgot their theoretical antibiotic knowledge over time, and they could not follow the current information because of the intensity of their working life. Both groups stated that post-graduation training could be used effectively for reducing antimicrobial resistance.Conclusions This study attempted to increase awareness to determine the difference in theoretical knowledge levels and behavior models of physicians before and after graduation. Sustainable antibiotic training for doctors after graduation will contribute positive effects to antimicrobial resistance and rational use of antibiotics.

Promoting rational antibiotic use in Turkey and among Turkish migrants in Europe – implications of a qualitative study in four countries

Background Antimicrobial resistance is considered one of the major threats to global health. The emergence of resistant microorganisms is a consequence of irrational use of antibiotics. In Turkey, the consumption of antibiotics is relatively high and antibiotics are among the most commonly used drugs. However, Turkey has adopted new, more restrictive policies and regulations on antibiotics. In addition, Turkish migrants to EU countries, such as Germany, the Netherlands and Sweden, may encounter health systems that promote a more restrictive and rational antibiotic use. The objective of this paper was to explore the variation in implemented policies related to rational antibiotic use that citizens in Turkey and Turkish migrants in Germany, the Netherlands and Sweden are subjected to and to discuss the implications for the promotion of rational antibiotic use. Data were collected through focus groups and individual interviews with citizens, physicians and pharmacists in the four countries. In total, 130 respondents were interviewed. Content analysis was used. Results Three relevant themes were identified: Implementation of regulations and recommendations, Access to antibiotics and Need for health communication. Irrational use of antibiotics was reported mainly in Turkey. While it had become less likely to get antibiotics without a prescription, non-prescribed antibiotics remained a problem in Turkey. In the three EU countries, there were also alternative ways of getting antibiotics. Low levels of knowledge about the rational antibiotic use were reported in Turkey, while there were several sources of information on this in the EU countries. Communication with and trust in physicians were considered to be important. There were also system barriers, such as lacking opportunities for physicians to manage care in accordance with current evidence in Turkey and factors limiting access to care in EU countries. Conclusions Several fields of importance for promoting rational antibiotic use were identified. There is a need for harmonisation of health-related regulations and policy programmes. Antibiotics should only be available with a prescription. Programmes for rational antibiotic use should be implemented on a broad scale, in medical care, at pharmacies and in the population. Methods for health communication and patient-centred care should be further developed and implemented in this field.

Curriculum update for future pharmacy technicians to enhance rational use of antibiotics in Turkey

Background Antimicrobial resistance (AMR) is one of the most important global public health issues and training of healthcare professionals and the public needs to be an integral part of all AMR efforts. In 2015, four out of six countries with the highest antibiotic consumption rate in the world were low and middle-income countries, where Turkey was reported as the country with the highest consumption. Methods This paper aims to present a new undergraduate course entitled “Rational use of antibiotics”, specifically designed for pharmacy technician students to increase their awareness on AMR and to equip them with knowledge and skills in promoting rational antibiotic use. The curriculum update was part of a larger international project, supported by the Erasmus+ KA2 Strategic Partnership Program (Project no: 2015-1-TR01-KA204-022393). Results Pharmacy technicians are among the most critical health professionals regarding rational antibiotic use because they can play a significant role in educating potential antibiotic users and have a multiplier effect in disseminating evidence-based knowledge. The 16-week long undergraduate course was designed by pharmacy and public health faculty with a multidisciplinary approach, focusing on topics such as epidemiology and control of communicable diseases, antibiotics, AMR and its public health consequences, legal regulations and medical practice regarding rational antibiotic use, as well as principles and methods of health promotion and health education. Conclusions Quantitative and qualitative evaluation of the newly introduced undergraduate course on the rational use of antibiotics showed promising results, which indicate that designing specific courses for health professions students to combat AMR can be more widely practiced in countries with high antibiotic consumption. Public health academics can take a leading role and responsibility in the design of such multidisciplinary courses for undergraduate programs in health care. Key messages Specific courses on rational use of antibiotics can be effective in changing knowledge, attitude, and behaviors of healthcare professionals, and consecutively the general public in combatting AMR. Public health academics can take a leading role and responsibility in design of such multidisciplinary courses for undergraduate programs in health care.

Dynamics of the microbiological scope and antibiotic susceptibility in intensive care unit patients

Introduction: This study addresses and evaluates the decrease of antibiotic resistance after introduction of a proposed prevention plan and control complex in the intensive care unit (ICU). Methods: Data from 1,111 bacteriological analyses, taken from patients who received treatment in the ICU of Ternopil University Hospital from January to August 2015 (group 1) and the same period of 2018 (group II), were included in the study. The complex included measures for the prevention of antibiotic resistance spread and for rational antibiotic use. Results: We found that resistance to imipenem changed more than other antibacterial drugs, increased by 60% (р ≤ 0.05), which was conditioned predominantly by Pseudomonas aeruginosa isolates for 100%. A decrease in 39% of polyresistant clinical isolates of Klebsiella pneumoniae in patients of groups I and II showed important prognostic value. Conclusion: A complex of the proposed measures included the division of patients in blocks according to the risk of infectious complications, control of antibiotics administration, adherence to sanitary norms by ICU staff, use of sodium hypochlorite resulting in decrease of pathogenic isolates, and level of antibiotic resistance to specific groups of antibacterial drugs.