First published as a blog post by the NIHR School for Primary Care Research.
NIHR Academic Clinical Lecturer, Dr Oliver van Hecke, describes his recent experience as a panel member on a All-Party Parliamentary Group event on antimicrobial resistance.
Wow! How often does one come face to face with people that can (in theory) provide your research with some very serious traction?
Such an opportunity came up for me at an event organised by the All-Party Parliamentary Groups (APPG) on Antibiotics, Pharmacy, and Dentistry/Oral Health held at the House of Commons in April 2019. This forum gives members of Parliament and Peers a chance to question a panel of experts in antimicrobial resistance (AMR) across primary care, dentistry and pharmacy. I was invited to be on the panel because of my work with the British Society of Antimicrobial Chemotherapy Council.
The aim of this APPG session was to discuss what primary care professionals can do to help ‘contain and control’ antibiotic resistance in the UK.1 As a GP at the coalface, and one with a specific research interest in this topic, I jumped at this opportunity to address MPs and Lords on what might be done in primary care to reduce antibiotic prescribing.
Fortuitously, my DPhil thesis (completed in 2018) was directly relevant to the issue.
WHY IS AMR AN IMPORTANT ISSUE FOR PRIMARY CARE?
Antibiotic resistance is an important societal health issue, especially in primary care where close to 80% of antibiotic prescribing occurs. Major contributors are all the unnecessary prescriptions of antibiotics for infections that would otherwise get better on their own. Typically, these infections are the coughs, sore throats, and ear infections (respiratory tract infections) that we all get from time to time. It is estimated that at least 1 in 3 of all antibiotics prescribed to people in the community do not help people get better any faster.
Theoretical predictions about the consequences of antibiotic resistance for future generations can seem pretty abstract, and both patients and clinicians may find them difficult to relate to. The impact of antibiotic resistance, the effect on clinical recovery from common infections, and other potential downsides of antibiotic prescribing for individuals, in the here and now, seems to have far greater relevance to patients and clinicians in their decision-making. Research from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, has shown that resistant bacteria make people in the community sicker for longer - even for common infections like urine infections managed in general practice.2 This means that everyday prescribing decisions do matter. In fact, the UK’s new five-year national action plan (2019–2024) specifically directs a 25% reduction for community antibiotic use by the year 2024 (compared with the 2013 baseline).
HOW CAN WE OPTIMISE ANTIBIOTIC PRESCRIBING IN PRIMARY CARE?
We started the APPG session discussing the progress that had been made thus far. I gave a summary of the evidence supporting the interventions likely to have the greatest impact. Essentially, there are five areas how GPs can optimise their prescribing:
- clinical prediction tools and algorithms
- education consultation kits e.g. RCGP Target Toolkit
- rapid diagnostic tests that are fit for purpose
- deferred/delayed prescriptions
- prescribing targets.
The panel agreed that the evidence for these approaches, although solid, had not been well enough adopted into usual practice because of a lack of a national implementation strategy supported by appropriate funding.
I was also able to underline the point that the decision to prescribe is usually a two-way street – a shared decision between prescriber and patient. Thus, we need to better tailor information to individual needs, to develop and test novel public engagement initiatives about self-care3, and to improve the message about the implications of unnecessary antibiotic use for individuals in the here and now.
My experience at the House of Commons was quite a daunting but wonderfully exciting opportunity to help communicate research evidence, which I had contributed to in my small way, to those who have their hands on the levers of power. My advice to other early career researchers: make yourself known, get your research out there, not just in the journals, but through any weird and wonderful opportunity that may come your way for direct public engagement.
- All-Party Parliamentary Group on Antibiotics. http://appg-on-antibiotics.com/meetings/what-can-primary-care-professionals-do-to-help-contain-control-antibiotic-resistance-in-the-uk/ [date accessed 17 May 2019]
- van Hecke O, Wang K, Lee J et al. The implications of antibiotic resistance for patients' recovery from common infections in the community: a systematic review and meta-analysis. Clin Infect Dis. 2017; 65(3):371-382 https://academic.oup.com/cid/article/65/3/371/3076117
Blog by British Dental Association: Can we reduce antibiotic prescribing by Susie Sanderson.
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