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Why Patient Involvement in Antimicrobial Stewardship Important

Why Patient Involvement in Antimicrobial Stewardship Important

Why Patient Participation matters to antimicrobial stewardship

Why Patient Involvement in Antimicrobial Stewardship Important

Patient engagement is increasingly recognised as a mechanism for improving health outcomes and reducing healthcare costs in various contexts.
This is Patient Involvement in Antimicrobial Stewardship
Antimicrobial overprescribing may be where patient engagement is a valuable adjunct to antibiotic stewardship efforts.
The field is evolving, but recent literature has found promising results.

The Problem of Antimicrobial Resistance

As recognised by the Centers for Disease Control and Prevention (CDC), World Health Organisation (WHO), and United Nations, the rise in antimicrobial resistance (AMR) across the globe is an undeniable reality.
Infections caused by antimicrobial-resistant bacteria are associated with poor patient outcomes and increased healthcare costs.
Strategies to stem the tide of AMR at the global and individual levels of impact are urgently needed, as indicated by the 2015 White House Plan.
Inappropriate antimicrobial use is the main driver of the rising AMR problem.
therefore, antimicrobial stewardship (AMS) and careful and responsible antimicrobial management are critical interventions for reducing AMR.

Antimicrobial Stewardship (AMS)

For over 20 years, stewardship efforts have been the rallying cry for reducing the spread of AMR.
Comprehensive initiatives, primarily in acute care inpatient settings, have positively impacted antimicrobial use.
Additionally, it reduces healthcare costs and, some studies, improves clinical outcomes such as shortened hospital stays, fewer adverse effects related to antimicrobials, and lower mortality.
Once seen as the purview of infectious disease physicians and pharmacists.
Obviously, it has become clear that effective ASPs require multidisciplinary representation due to the broad scope of stewardship.
Among the stakeholders typically included in a comprehensive ASP are hospital epidemiologist/infection control practitioners; hospital administrators; infectious disease physicians; specialists with interest in antimicrobials; directors of medical information systems, microbiology laboratory, outcomes or risk management, and environmental services.
In addition to the clinical pharmacy specialists, representation from the Pharmacy and Therapeutics Committee and organisational representative.
This multidisciplinary team is fundamental to devising, creating, and sustainably executing an ASP.

Patient Engagement in Healthcare Delivery and Research

What Is Patient Engagement?

Patient engagement in healthcare is defined as patients actively gathering information and making decisions about their symptoms, illnesses, and treatment options.
A more expansive definition includes a vibrant partnership between patients, their families, their representatives, and their healthcare team.
It also extends its reach into organisational governance and policy-making.
Patient engagement is a partnership between patients and the clinical professionals with whom they interact.
Clinicians engage and communicate with patients in their care, and patients share in making decisions and managing their conditions.
It’s not enough for doctors and nurses to reach out and provide information and options.
Additionally, it’s also not enough for patients to collect information and bring questions to their doctors.
If clinicians don’t provide education, encourage healthy habits, and stimulate patient involvement, patient engagement is not building.
For patient engagement to thrive, both sides must communicate regularly and commit to it.

Why Is Patient Engagement Important in Healthcare?

Since medical professionals are the experts, some may feel patients should follow their advice.
But research shows that when patients have a role in making decisions, they form a greater understanding and more substantial commitment to healing and health maintenance processes.
Higher patient engagement yields improved patient outcomes and cost savings.
In a study of 60,185 patients divided into two groups. One group received “usual” support from health coaches, while the other received “enhanced” support.
The study generated patient engagement outcomes across multiple metrics. For patients who received enhanced support instead of usual support:
- Total medical costs were 5.3% lower
- Inpatient admissions were 12.5% lower
- ER visits were 2.6% lower
- Surgeries were 9.9% lower
- Heart surgeries were 10.9% lower
From this and other studies, it’s clear that patients and providers can positively impact healthcare costs and patient outcomes through patient engagement.

Benefits of Patient Engagement in Your Practice

Patient engagement isn’t always easy. In a survey of 555 healthcare leaders and clinicians, 63% said “time investment by healthcare team” is the biggest challenge to building patient engagement in care delivery.
Here’s one narrative: Organizations that actively engage patients must spend more time with each patient, which means they can’t see as many patients each day, which means they have reduced income.
But that isn’t the whole story. In other ways, patient engagement in healthcare increases income and saves time.
Patient engagement research shows that the least-engaged patients are twice as likely to delay care and are three times more likely to have unmet medical needs than the most-engaged patients.
As patients become more engaged with their care, we see “higher levels of preventive health behaviours and preventive care, as well as increased self-management of health conditions.”
In short, when you invest time developing your patients’ engagement, they invest their time improving their health.
As a result, engaged patients are healthier patients who:
- Decrease your no-show rates
- Require fewer visits so you can take on more patients
- Stay with your practice because you are helping them maintain and improve their health
- Schedule appointments and look up their lab results, saving time for your organisation
Patient engagement will likely make your practice more efficient, profitable, and effective in the long run. This is Patient Involvement in Antimicrobial Stewardship

Current State of Patient Engagement in Stewardship Efforts

Despite the laudable goal of a patient-centred focus in a redesigned healthcare delivery system, the patient is notably missing from mention in stewardship committee composition.
A scan of the AS review literature, whether focused on an inpatient (the immediate context), ambulatory/outpatient, or long-term care setting.
It reveals that a mention of the patient typically occurs within the context of the patient as a passive recipient of interventions such as those targeting clinician-driven, antibiotic-prescribing decision models.
Research studies that are somewhat focused on patients include testing educational programs designed to facilitate conversations between patients and physicians about the need for antibiotics.
public service announcements about appropriate antibiotic use or pharmaceutical marketing campaigns and whether they drive consumer requests for an antibiotic.
These efforts primarily focus on evaluating patient expectations or perceptions and demand for antibiotics for such health conditions as acute respiratory infections and related symptoms.

Studies about State of Patient Engagement in Stewardship Efforts

Another study reported a reduction in prescription trends for pediatric patients between the ages of 24 and 48 months (4.2%) and between the ages of 48 and 72 months (6.7%) and posits that a comfort level with the practice of “watchful waiting” (delayed prescribing) based on suspected viral-based symptom resolution may at least partly explain this decline in antibiotic-prescribing patterns.
Other research focused on the “delayed prescribing” practice, including a systematic review of the strategy in acute respiratory infections, demonstrates a reduction in antibiotic prescriptions.
Antimicrobial prescribing and usage can be affected by contextual factors.
Some settings, i.e., areas outside the USA, afford access to antibiotics without prescription.
In these situations, the lack of use and dosage education for patients from a clinical source may add to the inappropriate use and spread of AMR.
Recently, researchers have started exploring the patient’s role in AMS efforts and programs.
Results of these efforts have shown heightened patient awareness of the prevalence of inappropriate antibiotic use and its impact on antimicrobial resistance.
the ability to modify their susceptibility to an infection requiring an antibiotic, such as by practising hand hygiene and strategies to prevent disease in the healthcare environment through contact precautions.
moreover, opportunities to effectively engage in shared decision-making about infection-related care approach when presented with several options.
This is Patient Involvement in Antimicrobial Stewardship

What Do Patients Think About Their Role in AMS?

A recent study exploring patient perceptions of AMS in an acute care setting identified three critical barriers for patients engaging in AMS efforts and influencing their perceptions of their vulnerability to being impacted by AMR:
- (1) patients have a high degree of trust in physicians to prescribe antibiotics judiciously,
- (2) patients do not understand the mechanism of antibiotic resistance, and
- (3) patients do not receive cues from healthcare providers (in a hospital setting)
Additionally, allowing patients to engage in conversations about options related to antibiotic use.
These three areas can be further studied to provide the next steps in overcoming these barriers.
There are other areas where the patient’s role in AMS efforts must be more thoroughly examined.
For instance, there may be opportunities to strengthen AMS endeavours by examining and learning from interventions modelled after patient involvement approaches in other areas of health management (for example, asthma, breast cancer treatment, cardiovascular health in diabetics).
Involving patients in shared decision-making is one aspect of this AMS equation with room for development.
In a small study reported at the International Conference on Infectious Diseases in 2016, researchers sought to understand the connection between shared decision-making and AS among hospitalised patients diagnosed with an infection in the UK.
During the interviews, the patients revealed feeling “empowered” by the unilateral nature of the clinicians’ handling of their infection care.
These feelings led to “loss of ownership, frustration, anxiety and ultimately distancing them from participation in decision making.”
This is Patient Involvement in Antimicrobial Stewardship

Activated and empowered patients

Becoming an informed and empowered patient who can ask questions and have constructive discussions with healthcare providers is essential from the viewpoint of several PAs.
however, this is something that not everyone is comfortable with unless there is guidance and encouragement from respectful healthcare providers:
As a patient, we play a role in our care.
Still, we are also at the mercy of physicians/healthcare providers who are too busy to follow up on sensitivity reports that indicate appropriate antibiotic sensitivity.
Patients need to educate themselves on what bacteria they may have and, if it is appropriate to treat, the risks of treating vs non-treatment.
Education for both healthcare providers and patients is essential.
Are you asking lay people to challenge their care providers? We are not the experts.
we trust them. Educate providers, not the public.
The literature brings valuable insights on this topic.
When studying hand hygiene, one study identified four components fundamental to patient empowerment: patient participation, patient knowledge, patient skills, and a facilitating environment.

Moreover:

Another study described several patient-related factors that patients’ willingness to participate in the redesign of healthcare processes, including acceptance of the new patient role, lack of medical knowledge, lack of confidence, comorbidity, and various socio-demographic parameters.
The promotion of patient participation is influenced by factors such as the desire to maintain control, lack of time, personal beliefs, and training in patient-caregiver relations:
Strength of patients’ role in managing their care can improve care outcomes. Therefore, leaders should encourage policies and interventions for patient activation and empowerment (Hibbard and Greene, 2013).
Consistently providing patients and families with or pointing them to quality health and patient education resources is vital in healthcare.
Self-efficacy can be enhanced by providing more opportunities for patients and families to engage public one’s health and healthcare:
My uncle died recently of pneumonia.
If we knew, we would have been more conscious of visiting, washing and what we touched.
This is Patient Involvement in Antimicrobial Stewardship

Effective communication strategies

There has to be information posted asking them to ask. Make it part of the culture.
A systematic review of 61 studies demonstrated that direct contact types of educational interventions are consistently more effective than mass media types.
Additionally, the individuals’ level of education may also affect their preference in the choice of education material.
The literature and narrative responses of PAs suggest that there is value in using several strategies simultaneously at different interaction points during the patient journey in the healthcare system.
therefore, the opportunity is to coordinate the right messages to reach patients.
the public and health professionals at the right time through the proper channels.
This is Patient Involvement in Antimicrobial Stewardship

For Effective timing

For the communication to be received, understood, and acted upon, it must be available at the most appropriate time.
which includes ongoing awareness building and education as well as on-demand information.
The PAs helped identify when they felt might be the most effective time to communicate about AMR and AMS.
In total, 90 % (n=54) believe that the best time to speak about AMR and AMS is when patients/families/public have questions or concerns, 78 % (n=47) when people are healthy, and 71 % (n=43) when people need care.
PAs commented on the importance of ensuring communication across the healthcare trajectory during crucial transition points in care.
for example, during admission and at discharge from an inpatient facility, before a doctor visit, at the pharmacy when picking up prescriptions and when under the care of a dentist:
Teach them young. Add this issue to curricula in schools. Add education for parents of young children.
This is Patient Involvement in Antimicrobial Stewardship.

In Effective messengers

Anticipating that PAs can draw from their experience with other initiatives to improve quality and safety.
Care providers were rated as the most effective according to 93 % (n=58) PAs, followed by peers (e.g. patient groups, family, friends) (82 %, n=50) and experts (73 %, n=44). In total, 66 % (n=40) of PAs felt that they, as a stakeholder group, could be effective at communicating this message too.
In the open-ended question fields, PAs also listed other vital stakeholders.
people responsible for training and setting protocols, community leaders, and those from other industries (e.g. agriculture):
Patient advisors can be influential if they are organised and mandated to inform different population segments.
Moreover, the patient advisors, could attend schools, work sites, and community meetings to briefly discuss the issue. People in their communities can be excellent advocates.
If they trust their neighbours and friends, passing on information is possible, and great things can happen.
Considering the previous points, patients are more receptive when they have questions or concerns and prefer one-on-one conversations with their healthcare provider.
Additionally, it is clear that healthcare professionals play a pivotal role in AS.
There is a complementary role for PAs to educate providers and patients, support the implementation of patient-centred care, promote patient empowerment or activation, and support campaigns nationally or locally in their communities:
There is a role for all of us. This is Patient Involvement in Antimicrobial Stewardship

The Effective messages

Consistent patient involvement in AMS will provide clear information, including real-life experiences (stories), making messages about AMS more effective.
Key points to include in messages include: when to expect antimicrobials and why they are not always appropriate.
How to prevent the spread of microbes, especially when receiving care.
Additionally, how to self-manage illnesses that do not require antimicrobials
How to take antimicrobials correctly and why it is essential.
Prevention is critical, although most don’t understand the dangers of antibiotic resistance because they are not ever witnessing the terrible cases that occur in care centres because of privacy.
It is always more meaningful if you could show examples with a bit of emotion tied I’llhem.
It’s essential to emphasise the prohibitive COST of treating ARO [antimicrobial resistant organisms] infections and outbreaks.
This reduces funds available for other patient care services.
This is Patient Involvement in Antimicrobial Stewardship

Conclusion

The rise in antimicrobial resistance (AMR) across the globe is an undeniable reality; despite the laudable goal of a patient-centred focus on a redesigned healthcare delivery system.
The patient is notably missing from mention in the stewardship committee composition.

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