Antimicrobial Stewardship: The Role of the Patient

Opinion Statement

The aim of this article is to describe the current state of the patient role in antimicrobial stewardship efforts. There is a global crisis in antimicrobial resistance (AR) for which antimicrobial use is the main driver. Antimicrobial stewardship (AS) is a critical ally in the battle against AR. The extent to which specific AS initiatives are implemented across settings varies considerably; many acute care settings have a formal antimicrobial stewardship program (ASP), but other patient care settings such as outpatient clinics or long-term care facilities are generally in the early phases of developing AS efforts which may include a regional approach encompassing transitions of care. In recognizing that a coordinated care approach across the spectrum of healthcare is essential to improve patient outcomes, there is a renewed and increased push to broaden AS implementation across multiple settings. In the acute care setting, a common characteristic of an ASP is a multidisciplinary team to guide antibiotic decision-making at an individual and a facility level. Efforts often target appropriate use of antimicrobials via formulary restrictions, prescribing decision-support models, education, and audit and feedback of prescribing practices. Patients are not usually included in stewardship efforts. Stewardship literature which includes a patient-role component is limited and focuses primarily on physician-patient communication or educational campaigns to raise public awareness of AS. There is little research exploring direct patient involvement in AS efforts, although there is some evidence that patients are aware of the implications of AR, its link to antimicrobial use, and its impact on health at the population level. Recent work has shown that patients believe there is a role for them in AS efforts; however, there is no guidance on the best approach to achieve patient involvement in AS initiatives and no evidence of the effect of such patient involvement on clinical outcomes. In order to fill the gap in knowledge related to the patient role in AS, we recommend the following for clinicians and researchers:

• Increase patient awareness and understanding of AS and the impact on their care. This may be the first step in successfully involving patients in AS endeavors.

• Identify situations in which patients can realistically become part of the AS movement across the healthcare spectrum. This would call for studying the process of patient recruitment and engagement and impact of adding the patient voice. This could also include studying patient perspectives about being involved in AS, along with clinician and researcher perspectives of involving patients.

• Undertake research studies to examine different implementation strategies for involving patients and evaluate the effect of engagement on clinical outcomes relevant to AS such as decreased antibiotic usage and antibiotic resistance.

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2lgYaK9
via IFTTT