Antimicrobial resistance


Improving patient engagement on AMR


A multidisciplinary effort at United Lincolnshire Hospitals NHS Trust is exploring a means of improving patient engagement regarding the risk of Antimicrobial Resistance (AMR), as well as ensuring effective infection management. This article outlines some key recommendations and strategies.


There is a need for increasing awareness within healthcare settings that, although the patient is the key person in their own healthcare, they are often missed out in crucial conversations relating to infection management and the risk of antimicrobial resistance (AMR). There are concerns that even when patients have contracted resistant infections, they are left with little or no information on what this means for them. This can influence health decisions and patient outcomes, and has knock-on consequences, such as a sense of anxiety about the future, which can affect family life and mental wellbeing. The drive to reduce inappropriate


antimicrobial use, in order to curb the emergence of resistance and incidence of difficult-to-treat infections, requires a long and multifaceted strategy, and success is limited by a lack of awareness among healthcare professionals, the patients, and the public. More actions must be taken now, for individual patient benefit, and as part of global efforts to


tackle the biggest threat to medical care. This article aims to explore the concept of patient engagement with AMR, from a UK hospital care perspective, and concludes with a list of recommendations for national and international consideration in guidelines and strategy.


Background The UK Prime Minister’s call for an independent review on AMR in 2014 (chaired by Lord Jim O’Neil), set into motion a series of chilling reports and heightened awareness of the extent of actions required in tackling AMR. The UK government response to funding AMR initiatives and progressing meaningful initiatives2


included a pledge to increase


understanding and awareness of AMR, and ambitions for a global public campaign. There was significant UK coverage of this in documentaries and mainstream media news, including by the British Broadcasting Corporation (BBC).3 National policy and targets have been


embedded into various frameworks in secondary care, including the National Health Service (NHS) National Standard contract and National CQUINs,4,5


as well as bespoke toolkits


for implementation that are backed by Criterion 3 in the obligatory Health and Social Care Act. These targets are focal points of Care Quality Commission assessments in all localities,6-8


with


an outpouring of surveillance data and reports, such as the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR).9 Considerations were also given to how


areas of deprivation, socio-economic factors, and complications arising for vulnerable patient groups, can affect healthcare-seeking behaviours and the likelihood of antimicrobial prescribing.10,11


The prescribing trends and


surveillance within the rural locality of the authors support this observation, as limited and challenging access to healthcare providers correlates to higher volume of antimicrobial prescribing compared to other areas, even after adjusting for population density and characteristics. Are we using the AMR resources or


frameworks consistently and effectively? How much do we understand about patient engagement with AMR? Specialists’ focus has been on engaging with non-specialists on prudent use of antimicrobials, with some attention on patient-facing information that is potentially not reaching as far and wide into the public domain or understanding as intended.12–14 It is difficult to delineate evidence-based patient engagement in this field, with very few studies that capture patient perspective, concerns, understanding of the information provided and/ or the effect of the provided information on their understanding of infection management and AMR.15,16 The authors believe that improved patient engagement with AMR will have a great potential in reducing inappropriate antimicrobial prescribing. The focus of this article is to explore


December 2023 I www.clinicalservicesjournal.com 21


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