Today marks the start of World Antimicrobial Awareness Week 2022, a joint initiative of the Food and Agriculture Organization of the United Nations, the United Nations Environment Programme, the World Health Organization and the World Organisation for Animal Health.
In Europe, 33,000 people die every year from antibiotic-resistant infections. This growing resistance of bacteria to antibiotics – antimicrobial resistance (AMR) – is a global threat with consequences for human health, animal health and the environment. All agree that the misuse and overconsumption of antibiotics is a major contributor to the acceleration of this phenomenon.
Addressing this specific issue, last month a new public information campaign was launched by Santé Publique France (Public Health France) on the proper use of antibiotics – ie only when prescribed by a health professional.
So how can we reduce overconsumption of antibiotics? Two approaches seem important to us here at BIT. Firstly working with doctors to help them prescribe better (ie less), and secondly helping the general public to consume these medicines better (also less).
1. Helping doctors prescribe better
In France, about one third of current antibiotic prescriptions are considered unnecessary. In December 2021, BIT France worked with government agencies DITP (la Direction interministérielle de la transformation publique), Assurance Maladie and AntibioEst to redesign the feedback forms sent by Assurance Maladie to doctors to make them aware of avoidable antibiotic prescriptions. BIT’s previous work on AMR has shown that providing feedback to doctors on their behaviour can be very effective at reducing over prescribing.
This work led to the development of a new feedback system, informed by listening to GPs, which includes features such as:
- Show the quality (ie appropriateness), rather than the quantity, of practitioners’ antibiotic prescriptions
- Putting forward a single, overall score to help the clinician understand at a glance whether his or her prescriptions are in line with public health recommendations.
- Giving GPs the opportunity to set personal targets for reducing unnecessary prescriptions
- Using exercises to get doctors to estimate their prescription rates before sharing the actual rates with them. Since as individuals our estimates are often inaccurate, this technique can create awareness that leads to behaviour change. This approach has been used successfully in the US to reduce opioid prescription rates.
Prototypes for the new feedback system to GPs
This ambitious new system will now be rolled out to healthcare professionals in the Grand Est region of France next year and evaluated in 2024. We look forward to sharing the results in due course.
2. Empowering patients by filling information gaps
Although antibiotics are only available on prescription in France, patients also have a role to play. Namely that it is crucial that they not only don’t use them without a prescription, but also that they avoid asking their doctor for antibiotics. In 2020, 33% of GPs in France reported frequently have patients who insist on being given antibiotics
For this part of the project we worked with Santé Publique France to identify approaches for a public awareness campaign. The results obtained through an online survey with a representative sample of 4000 adults across France highlighted some important findings:
- Everyone knows the slogan “Antibiotics are not automatic” from a communication campaign carried out in France previously in 2002, however not everyone knows in which cases they should (or should not) be taken. For example, one in five participants (21%) thought that “antibiotics work on viral infections and not on bacterial infections”, when the complete opposite is correct.
- Communicating about the threat of antibiotic resistance does not seem to be a promising strategy, at least in the short term. Rather it seems to have actually exacerbated existing misconceptions about AMR, which at this time is still poorly understood by the public.
- The brevity of the message was found to be more important than extensive pedagogy in communicating good use messages. Direct communication about specific situations where antibiotics are not useful increased participants’ knowledge and intention to act on their own antibiotic use.
On the basis of this study, we recommended that the following elements be communicated in a sequenced manner:
- A short message focused on raising awareness of the proper use of antibiotics, including concrete situations where antibiotics are unnecessary.
- A message that raises awareness of the consequences and damage caused by the global overuse of antibiotics and insists on personal responsibility to act
- Scientific messages communicated in non-specialist terms and in a longer format explaining the mechanisms of antimicrobial resistance
Santé Publique France’s new public information campaign (below) illustrates this first point. We look forward to seeing the effects.