A LOCAL EXAMPLE

4. A LOCAL EXAMPLE

For education to be successful, both professionals and patients must be given the same knowledge at the same time. For example, it is unlikely that educating professionals alone will be significant in changing practice if patients are still unaware of the need to change their behaviour and continue to inappropriately attend the GP and “demand” antibiotics. Even the best inten- tioned professional will be quickly worn down and enthusiasm to put into practice “negotiating” skills will soon wane, when faced with resistance or the time-consuming task of educating an unwilling and unreceptive patient him- self. In addition, education at this point, when the patient has clearly come in with an agenda to get antibiotics, that is, is at the pre-contemplation stage, is unlikely to be successful.

Similarly, campaigns targeted at the patient alone, will likewise fail, if they attend their pharmacist for self-medication/symptomatic remedies, but are referred immediately to the GP who because he thinks the patient expects it, prescribes an antibiotic (Little et al., 1997)

To coordinate patient and professional education together probably needs to be done at a locality level. An example of such a campaign, carried out in my local NHS area illustrates that this can be done, using some of the educa- tional techniques already described in the preceding sections.

The campaign, started in 1998, was in response to the then recently pub- lished SMAC report and local trends for slightly higher than average use of antibiotics per 1,000 population than for Scotland. Taking on board the princi- ples outlined above, eye-catching leaflets were designed by the local health promotion department, promoting the message that for colds and flu antibi- otics were “not the answer.” These were displayed primarily in doctors’ surgeries and pharmacies. More detailed “serious” looking informative typed A4 sheets were also prepared with self-help guidance including symptoms, symptomatic

542 Christine Bond relief, and when to call the doctor. It was envisaged that these sheets could be

used as part of the consultation, proffered instead of a prescription and ulti- mately computer generated and individualised. Exact wording of both of these leaflets had to be developed with care, because on the one hand, there is a need to discourage unnecessary GP attendance, but on the other hand issues of lia- bility might arise if a patient wrongly did not seek medical help and serious morbidity or mortality resulted.

At the same time, information was sent to GPs and pharmacists reminding them of best practice in using antibiotics, sending copies of the SMAC report, copies of the patient leaflets, information on local prescribing trends, and their exact practice position with respect to these—that is, practice feedback and audit, to coin one of the well used terms in dissemination strategies.

In addition advertising slots were purchased on buses and local radio and the press were invited to cover the campaign. Preliminary evaluation at the end of the first year showed pharmacists and GPs had valued the initiative, believed it had helped and requested more leaflets for other common conditions. These have already been mentioned in Section

2.3.1. A subsequent more in-depth evaluation of patient knowledge and behav- iour, while confounded because of a lack of a control group and limited sampling, indicated that many patients did appreciate the issues around antibiotic resistance, although were not always ready to translate this knowledge into their own behav- iour when experiencing an infective illness. This second evaluation also demon- strated the need to involve the wider healthcare team in the campaign (Emslie and Bond, 2003). With the increased role of nurses in the management of minor ill- nesses and as prescribers and as educators, this was particularly pertinent and nurses and health visitors were included in campaigns in subsequent years.

Examination of current prescribing trends indicates that the prescribing of antibiotics in Grampian has decreased faster than in other Health Board areas in Scotland. Although absolute differences are small and there has been no control group, the indicators are that the campaign has had modest success in reversing the previous trends.