An informed public's views on reducing antibiotic overuse

Richmond, Jennifer; Mangrum, Rikki; Wang, Grace; Maurer, Maureen; Sofaer, Shoshanna; Yang, Manshu; Carman, Kristin L.

doi:10.1111/1475-6773.13175

Cited by 7 publications

(4 citation statements)

References 43 publications

(117 reference statements)

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“…Patients seemed to have been more prepared to openly deliberate on prescribing decisions and their expectations were more explicit than previously, even though trust in clinician still had a major role to play. 12,19,33 Those participants who emerged as informed patients rejected a blind compliance. Indeed, patient expectations were due to disclosure; for example, it was manifested in the consultations that used 11,19,34,35 Instead of trying to read the patient's mind, prescribers were and must be making the expectations apparent by asking about them.…”

Section: Experience Of Taking Antibioticsmentioning

confidence: 99%

Revisiting patient expectations and experiences of antibiotics in an era of antimicrobial resistance: Qualitative study

Boiko

Gulliford

Burgess

2020

Health Expectations

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Objective To investigate contemporary patient expectations and experiences of antibiotic prescribing in England. Background Primary care providers’ compliance with patient influences has been identified as a motivation for antibiotic‐prescribing behaviour. Since 2013, there have been concerted efforts to publicize and address the growing threat of antimicrobial resistance. A fresh qualitative insight into patient expectations and experiences is needed. Design Qualitative study using semi‐structured interviews. Setting and participants Two English regions, one an urban metropolitan area and the other a town in rural England. Patients who recently consulted for infections were recruited. The information power approach was used to determine the number of participants, yielding a sample of 31 participants. Main measures Thematic analysis was carried out to analyse the interview data. Results Five themes were identified: beliefs, expectations, experiences of taking antibiotic, experience of antimicrobial resistance and side‐effects, and experiences of consultations. The accounts reflected improved public knowledge: antibiotics were perceived to be much‐needed medicines that should be prescribed when appropriate. The data showed that patients formed expectations of expectations, trying to read the prescribers’ intentions and reflect on the dependency between what prescribers and patients wanted. Patient experiences featured as nuanced and detailed with knowledge of AMR and side‐effects of antibiotics in the context of positive consultation experiences. Conclusions The study highlighted complex interplays between adherence to antibiotics and consuming antibiotics in reflexive, informed ways. Ensuring that present and future patients are informed about potential benefits and harms of antibiotic use will contribute to future antimicrobial stewardship.

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Section: Experience Of Taking Antibioticsmentioning

confidence: 99%

Revisiting patient expectations and experiences of antibiotics in an era of antimicrobial resistance: Qualitative study

Boiko

Gulliford

Burgess

2020

Health Expectations

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“…The literature search resulted in 46 statements representing knowledge gaps and misconceptions about antibiotic use. The statements were extracted from a total of 27 publications ( Supplementary File S1 ) [ 6 , 8 , 9 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. These statements were divided into four domains: (1) AMR in general, (2) use of antibiotics in general, (3) antibiotics for acute respiratory tract infections, and (4) antibiotics for urinary tract infections.…”

Section: Resultsmentioning

confidence: 99%

Misconceptions and Knowledge Gaps on Antibiotic Use and Resistance in Four Healthcare Settings and Five European Countries—A Modified Delphi Study

Chalkidou,

Lambert,

Cordoba

et al. 2023

Antibiotics

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Misconceptions and knowledge gaps about antibiotics contribute to inappropriate antibiotic use and antimicrobial resistance. This study aimed to identify and prioritize misconceptions and knowledge gaps about antibiotic use from a healthcare professionals’ perspective. A modified Delphi study with a predefined list of statements, two questionnaire rounds, and an expert meeting was conducted. The statements were rated by healthcare professionals from France, Greece, Lithuania, Poland, and Spain, and from general practice, out-of-hour services, nursing homes, and pharmacies. A total of 44 pre-defined statements covered the following themes: (1) antimicrobial resistance in general, (2) use of antibiotics in general, (3) use of antibiotics for respiratory tract infections, and (4) use of antibiotics for urinary tract infections. Consensus was defined as ≥80% agreement between the professionals during the second Delphi round. For 30% of the statements, professionals from the four settings together reached consensus. In each setting individually, at least 50% of the statements reached consensus, indicating that there are still many misconceptions and knowledge gaps that need to be addressed. Six educational tools (leaflets, posters, checklists) were developed to address the knowledge gaps and misconceptions. These can be used by patients and healthcare professionals to improve the use of antibiotics in practice.

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“…108 Recently, it has been shown that when informed about individual and social consequences of antibiotic overuse, patients may be more receptive to antibiotic prescription limits. 109 This evidence suggested that the patient role involves staying informed about the issue of antibiotic use and considering potential benefits and harms when making decisions about antibiotic use. We found that informed patients (of antibiotics and the associated risks) displayed more satisfaction with the consultation.…”

Section: Discussionmentioning

confidence: 99%

Safety of reducing antibiotic prescribing in primary care: a mixed-methods study

Gulliford

Charlton

Boiko

et al. 2021

Health Serv Deliv Res

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Background The threat of antimicrobial resistance has led to intensified efforts to reduce antibiotic utilisation, but serious bacterial infections are increasing in frequency. Objectives To estimate the risks of serious bacterial infections in association with lower antibiotic prescribing and understand stakeholder views with respect to safe antibiotic reduction. Design Mixed-methods research was undertaken, including a qualitative interview study of patient and prescriber views that informed a cohort study and a decision-analytic model, using primary care electronic health records. These three work packages were used to design an application (app) for primary care prescribers. Data sources The Clinical Practice Research Datalink. Setting This took place in UK general practices. Participants A total of 706 general practices with 66.2 million person-years of follow-up from 2002 to 2017 and antibiotic utilisation evaluated for 671,830 registered patients. The qualitative study included 31 patients and 30 health-care professionals from primary care. Main outcome measures Sepsis and localised bacterial infections. Results Patients were concerned about antimicrobial resistance and the side effects, as well as the benefits, of antibiotic treatment. Prescribers viewed the onset of sepsis as the most concerning potential outcome of reduced antibiotic prescribing. More than 40% of antibiotic prescriptions in primary care had no coded indication recorded across both Vision® and EMIS® practice systems. Antibiotic prescribing rates varied widely between general practices, but there was no evidence that serious bacterial infections were less frequent at higher prescribing practices (adjusted rate ratio for 20% increase in prescribing 1.03, 95% confidence interval 1.00 to 1.06; p = 0.074). The probability of sepsis was lower if an antibiotic was prescribed at an infection consultation, and the number of antibiotic prescriptions required to prevent one episode of sepsis (i.e. the number needed to treat) decreased with age. For those aged 0–4 years, the number needed to treat was 29,773 (95% uncertainty interval 18,458 to 71,091) in boys and 27,014 (95% uncertainty interval 16,739 to 65,709) in girls. For those aged > 85 years, the number needed to treat was 262 (95% uncertainty interval 236 to 293) in men and 385 (95% uncertainty interval 352 to 421) in women. Frailty was associated with a greater risk of sepsis and a smaller number needed to treat. For severely frail patients aged 55–64 years, the number needed to treat was 247 (95% uncertainty interval 156 to 459) for men and 343 (95% uncertainty interval 234 to 556) for women. At all ages, the probability of sepsis was greatest for urinary tract infection, followed by skin infection and respiratory tract infection. The numbers needed to treat were generally smaller for the period 2014–17, when sepsis was diagnosed more frequently. The results are available using an app that we developed to provide primary care prescribers with stratified risk estimates during infection consultations. Limitations Analyses were based on non-randomised comparisons. Infection episodes and antibiotic prescribing are poorly documented in primary care. Conclusions Antibiotic treatment is generally associated with lower risks, but the most serious bacterial infections remain infrequent even without antibiotic treatment. This research identifies risk strata in which antibiotic prescribing can be more safely reduced. Future work The software developed from this research may be further developed and investigated for antimicrobial stewardship effect. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

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An informed public's views on reducing antibiotic overuse

Cited by 7 publications

References 43 publications

Revisiting patient expectations and experiences of antibiotics in an era of antimicrobial resistance: Qualitative study

Revisiting patient expectations and experiences of antibiotics in an era of antimicrobial resistance: Qualitative study

Misconceptions and Knowledge Gaps on Antibiotic Use and Resistance in Four Healthcare Settings and Five European Countries—A Modified Delphi Study

Safety of reducing antibiotic prescribing in primary care: a mixed-methods study

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