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.
Parts
» Antibiotic Policies: Theory and Practice
» THEORIES OF FACILITATING CHANGE
» OTHER APPROACHES TO GUIDELINE DEVELOPMENT
» QUALITY ASSURANCE AND DEVELOPMENT OF STANDARDS
» DEVELOPMENT OF CLINICAL STANDARDS IN SCOTLAND
» WHICH QI INTERVENTIONS HAVE BEEN STUDIED IN CAP?
» LINKING PROCESS OF CARE TO OUTCOMES IN QI
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE PROCESS OF CARE IN CAP?
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE OUTCOMES IN CAP?
» Designing and implementing a CAP intervention
» LEVEL OF AGGREGATION OF ANTIMICROBIALS
» ANTIMICROBIAL USAGE MEASURES
» Relationships based on patient-specific data
» Relationships based on aggregate usage
» ANTIBIOTIC CONSUMPTION; ALTERNATIVE UNITS OF MEASUREMENT
» ANTIBIOTIC CONSUMPTION CALCULATOR
» BENCHMARKING FOR REDUCING VANCOMYCIN USE AND VANCOMYCIN- RESISTANT ENTEROCOCCI IN US ICU S
» THE HARVARD EMERGENCY DEPARTMENT QUALITY STUDY
» ANALYSIS BY INDIVIDUAL ANTIMICROBIAL AGENT
» BENCHMARKING WITH OTHER ANTIMICROBIAL UTILISATION DATA
» STATE OF THE ART OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» AUDITING AND IMPROVING THE QUALITY OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» TYPES OF STUDIES TO OBTAIN QUALITY DATA ON A PATIENT LEVEL
» MULTIDISCIPLINARY ANTIMICROBIAL MANAGEMENT TEAMS
» THE ROLE OF THE PHARMACIST IN INFECTION MANAGEMENT
» TRAINING AND SUPPORT IN INFECTION MANAGEMENT FOR PHARMACISTS
» ANTIBIOTIC POLICY IN THE TERTIARY CARE CENTRE
» ANTIBIOTIC CONSUMPTION IN ICU S
» ANTIBIOTIC RESISTANCE IN ICU
» The impact of antibiotic policies and antibiotic consumption on antibiotic resistance
» IT and benchmarking to improve antibiotic prescribing
» COST OF HOSPITAL-ACQUIRED INFECTION
» THE COST OF ANTIMICROBIAL RESISTANCE
» Costs of screening/surveillance cultures
» Isolation, cohorting, and contact isolation
» EPIDEMIOLOGY OF INVASIVE FUNGAL INFECTIONS
» Antifungal resistance in Candida species
» Antifungal resistance cannot be transmitted by extrachromosomal DNA
» RATIONAL USE OF ANTIFUNGAL AGENTS
» THE CHANGING FACE OF VIRAL INFECTIONS AND THEIR MANAGEMENT
» PROBLEMS ASSOCIATED WITH ANTIVIRAL THERAPY
» ANTIVIRAL TREATMENT STRATEGIES
» ANTIVIRAL PROPHYLAXIS STRATEGIES
» ANTIBIOTIC CONCENTRATIONS AT TARGET SITES
» An infant with aplastic anaemia
» A long-standing E. coli infection of liver cysts
» BREAKPOINTS: A SHORT HISTORY AND OVERVIEW
» PHARMACODYNAMIC RELATIONSHIPS AND EMERGENCE OF RESISTANCE
» EVALUATION OF THE ANTIMICROBIAL RESISTANCE SURVEILLANCE DATA PUBLISHED IN THE MEDICAL LITERATURE
» PRACTICAL ASPECTS OF THE IMPLEMENTATION OF THE SURVEILLANCE PROGRAM
» Multivariate analysis methods
» Evolutionary genetic approaches
» Study of the relationship between bacterial resistance and antimicrobial consumption
» To predict the short-term evolution of resistance
» To evaluate interventions to control antibiotic resistance
» DISINFECTANTS: TYPES, ACTIONS, AND USAGES
» Evidence of bacterial resistance to biocides
» Mechanisms of bacterial resistance to biocides
» EVIDENCE OF CROSS-RESISTANCE BETWEEN BIOCIDES AND ANTIBIOTICS
» DISINFECTANT USAGE AND ANTIBIOTIC RESISTANCE
» METHODS OF LITERATURE REVIEW
» PROBLEMS WITH INTERPRETATION OF PUBLISHED STUDIES
» Distribution of educational materials
» Audit and feedback with or without other educational materials
» Educational group meetings or seminars
» Educational outreach/academic detailing
» Financial/healthcare system changes
» EFFECT OF INTERVENTIONS ON ANTIBIOTIC RESISTANCE
» DDD/1,000 INHABITANTS AND DAY (DID)
» PRESCRIPTIONS/1,000 INHABITANTS AND YEAR
» INDICATIONS FOR ANTIBIOTIC PRESCRIPTIONS
» POSSIBLE CAUSES FOR OBSERVED VARIATIONS IN ANTIBIOTIC USE
» DETERMINANTS OF ANTIBIOTIC CONSUMPTION
» COLLECTIVE AWAKENING AND PROGRESSIVE MOBILIZATION OF FRENCH PUBLIC HEALTH AUTHORITIES
» ANTIBIOTIC USE AND COST TRENDS
» IMPACT ON HEALTH BUDGETS OF ANTIBIOTIC USE
» ACCESS TO ESSENTIAL ANTIBIOTICS AT ALL LEVELS OF CARE
» EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE
» THREAT OF ANTIMICROBIAL RESISTANCE
» ECONOMIC IMPLICATIONS OF ANTIMICROBIAL RESISTANCE
» FACTORS CONTRIBUTING TO DEVELOPMENT AND SPREAD OF RESISTANCE
» STRATEGIES FOR CONTAINMENT OF RESISTANCE IN DEVELOPING COUNTRIES
» Antibacterial resistance and policies
» Policies, guidelines, and education on antibacterial use
» Discovery, development, and commercialization in the face of policies
» Antibacterial development, labelling, and benefits
» WHAT CAN BE DONE NOW ABOUT ANTIBIOTIC RESISTANCE?
» HOW CAN THE DIAGNOSTIC LABORATORY HELP?
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