Local activations of GRIP messaging
Since the last GRIP meeting, members have been working to disseminate GRIP messages at a local level across the world. Members were asked to profile some of their activities, many of which have been developed in collaboration with RB representatives at a local level.
Prof. Pignatari outlined how he had been working to extend the work of GRIP in Brazil. In 2013 he led a symposium at an ear, nose and throat (ENT) conference attended by over 130 clinicians. Looking at the challenges of antibiotic resistance, Prof. Pignatari’s presentation was supported by a questionnaire that asked delegates about their challenges with antibiotic stewardship. Some 60 attendees completed the questionnaire from which:
- 72.6% of respondents agreed that it was difficult, but not impossible, to convince patients that antibiotics are not required for URTI
- 64.5% of respondents agreed the main responsibility lay with doctors when ensuring antibiotics were used appropriately for URTIs
- 100% of respondents rated the GRIP idea as a very good idea.
In 2014, Prof. Pignatari will be working on a number of symposia in Saõ Paulo and Rio de Janeiro to help understand the position and acceptance of the GRIP concept amongst GPs.
In Germany, Prof. Altiner has been leading activities around changing antibiotic prescribing behaviours. Germany has a low prescription rate for antibiotics compared to other countries in Europe.8 However, there is still a need to educate HCPs in appropriate antibiotic use. Chairing the local advisory board, Prof. Altiner and colleagues discussed the need to enhance patient education around appropriate use of antibiotics with a pro-active, positive ‘protect antibiotics’ message. The group is now looking to raise awareness of the global GRIP initiative and develop a hard-hitting campaign, aligned with GRIP, to educate and improve the doctor-patient dialogue. The group hopes to inspire a change that prompts less antibiotic use and encourages trust in symptomatic relief as the first-line treatment in URTIs.
“In most cases of respiratory infections, you do not need antibiotics. You will recover as fast as without” - Prof. Altiner
Prof. Altiner also introduced a newsletter that will be developed in 2014 by the German group, who are called AHA! In addition, key messages around antibiotic use will be developed and translated into languages commonly spoken in Germany in order to improve communication where German is not the patient’s first language.
Austria and Switzerland
In Austria and Switzerland two advisory boards have been convened with local experts: ‘NEXT’ in Switzerland and ‘ART’ in Austria. The advisory boards met to discuss the GRIP messages in November 2013, aligned around European Antibiotics Awareness Day. Delivered and planned activities include scientific publications, training sessions and pharmacy lectures.
GRIP member Dr Martin Duerden went to Saudi Arabia to give a presentation entitled: ‘Antibiotic use in respiratory tract infections—local approaches to address the global problem of antibiotic resistance’. He addressed both a small meeting and a larger group of 100 healthcare professionals consisting of ENT specialists, microbiologists and Ministry of Health officials. This presentation introduced the GRIP 5P framework, the 1, 2, 3 approach and current activations worldwide. The GRIP toolkit was showcased and GRIP activities to date summarised.
Looking at activities in Italy, Dr Sessa gave an overview of a small study he conducted locally. At present, Dr Sessa said, the majority of patients visit their pharmacy to treat sore throat (60%) with the remainder visiting their GP (40%). His study set out to understand antibiotic prescribing behaviours within his practice, and to see if the GRIP resources could actually deter inappropriate prescribing behaviours.
Some 170 patients visited the surgery for sore throat during the time frame of the study. On average, patients presented with a sore throat three days post-onset of symptoms. Prior to visiting the doctor, the majority of patients had taken paracetamol (58%), while 11% of patients had not taken any medication.
Almost 60% of patients did not receive a prescription for antibiotics, 29% received amoxicillin and 9% received amoxicillin-clavulanate. One third of the antibiotic prescriptions were considered inappropriate, said Dr
Sessa. The prescribing of antibiotics was considered appropriate if:
- exudate (pus) is observed on the first consultation;
- the patient consults for a second time;
- the patient has attended an emergency department;
- the patient was referred to a specialist;
- high-risk criteria are indicated, following
The high number of inappropriate prescriptions shows that better antibiotic stewardship is needed. Fewer patients received antibiotics during consultations where the GRIP toolkit materials were used.
“One third of antibiotic prescriptions were considered inappropriate" - Dr Sessa
Following the GRIP Summit 2013, GRIP member Dr Martin Duerden has been instrumental in bringing the initiative to life in the UK. Activities began with a UK advisory board comprised of Dr Emma Whitehouse, a GP and a Royal College of General Practitioners (RCGP) Clinical Support Fellow in Antimicrobial Stewardship; Dr Donna Lecky, Project Manager of the European e-Bug project within the Primary Care Unit, Public Health England; Dr Terrence Maguire, pharmacist and Honorary Senior Lecturer, School of Pharmacy, Queens University Belfast; and Mr Jonathan Mason, a pharmacist currently working for NHS England.
The group discussed the issues within the UK and what could be done to address these at a GP, pharmacy and patient level. The group helped adapt the GRIP toolkit for the UK releasing this in time for Antibiotics Awareness Day in November 2013. Resources included a ‘Call to Action’ report around antibiotic stewardship and HCP and patient materials that were mailed to 9,000 GP practices in the UK. Positive feedback on the toolkit resulted in requests for 10,000 additional resources. Dr Duerden also authored a GP Fact File, which was distributed with a GP magazine, which has a reach of 34,500 GPs. Furthermore, an online CPD module which accompanied the piece will be available for the next 12 months. For pharmacy, an educational module was developed on antibiotic resistance with recommendations to change behaviour in this setting.
This is in the context of further work being undertaken to reduce unnecessary or inappropriate antibiotic use around the UK; the Chief Medical Officer for England has been highly active in raising concerns about antibiotic resistance and a UK Action Plan has been developed. The UK RCGP in collaboration with other partners has developed resources to support safe, effective, appropriate and responsible antibiotic prescribing (available at: www.rcgp. org.uk/clinical-and-research/target-antibiotics-toolkit.aspx). The National Institute for Health and Care Excellence (NICE) is in the process of developing a guideline on antimicrobial stewardship.
“The subject of antibiotic resistance has been a key topic in the Australian Prescriber, an independent journal providing evidence-based information for HCPs, and the issue of antibiotic stewardship in both hospitals and the community has been raised as one of major concern by the Australian Commission on Safety and Quality in Healthcare,” said Mr Bell. The Resistance Fighter campaign, led by the National Prescribing Service, was involved with Antibiotic Awareness week in 2013, inviting HCPs and the public to take a pledge to fight antibiotic resistance. Resources are available to download from the NPS MedicineWise website (www.nps.org.au).
Prof. Essack is driving the GRIP approach in South Africa and has completed a baseline survey around antibiotic usage that is to be published. In total, 386 doctors completed the survey. The aim was to understand which first-line treatments and adjunct treatments are prescribed for various infections— including colds, flu and throat infections—and attitudes towards antibiotic use. A South African Advisory Board is in the process of being constituted.
Prof. Kozlov said that major advances are being made in Russia with the Russian government listing antibiotic resistance as a top priority and one of six key parameters for health. Three large conferences are planned for 2014 and an action plan for antibiotic resistance is being developed.