Presentation on Antibiotics A Patient Perspective

Transcription

1 Presentation on Antibiotics A Patient Perspective When I was asked to put forward the Patient Perspective on the use of antibiotics and to think about how to persuade the public to think about whether they need an antibiotic first before assuming they need one, I decided to do some impromptu research. The overwhelming initial response from the 42 people of all ages that I asked was I want an antibiotic! Thus, I thought this was going to be a very short presentation! However, I decided to ask why there was such resistance to not using antibiotics? From this several themes began to emerge. The main one being was that they had become so comfortable with the use of antibiotics that they didn t realise the dangers of over-use. Many didn t really understand the difference between viral and bacterial infections. Those who were over 70 were very conscious of life before antibiotics were widely adopted and were generally more aware of when to ask for one, but were also more wary of the consequences of not having access to treatment when they felt it was necessary. I say treatment because on discussion about other options, on explanation, they were prepared to consider potential alternatives. The most resistant to not receiving an antibiotic were those in work or those with other Long Term Conditions. Those with long term Conditions who need antibiotics e.g. those with emphysema etc, should have access to them and even have a course at home that they can start when they are aware that they should take them. Most I know who are successfully self-managing their long-term condition use the treatments they have appropriately and with care. For those in work the worry was the impact of feeling unwell for several days, the need to take sicktime and the financial implications if their employment became in jeopardy due to repeated small absences. This was more common amongst those working in the public sector, especially the police and the health service where there are active policies to reduce absences from work and if off more than twice in a six month period, an interview with Human Resources is required. Repeatedly I was told that if an antibiotic helped them to feel better quickly and kept them from taking time off work, then that was what they wanted to happen, regardless of the bigger picture. However, I think it does raise issues that employers need to face if employees are afraid to take time off when genuinely unwell, who then come to work clearly unwell and then pass that infection around their colleagues, ultimately creating more absences from the workplace than 1

2 there would have been if the initial employee had taken a couple of days off to get over the infection. What also became evident was that the majority of those questioned, often with degrees and in professional careers, were not aware of the issues of the side effects of the use of antibiotics. Almost all who didn t have a background in health, didn t realise that the use of antibiotics affected the bacterial flora in the gut and that certain antibiotics could leave you more prone to other infections such as Clostridium Difficile. Most of the females though did associate the use of Trimethoprim for a UTI with an outbreak of vaginal thrush. With regards to dental problems, many didn t have access to an NHS dentist, and even if they did, there was concern over the financial cost of having the crown removed and replaced in order to drain an abscess etc the choice between up to 500 for the crown or a course of antibiotics that are free? To a man, everyone I asked wanted the antibiotic! It was seen as a quicker way to feel better, would reduce the pain within their mouths, and would remove the need for financial pain! Thus, there is an uphill task to be done to affect this viewpoint. When asked about the emergence of resistance to antibiotics, it rapidly became clear that most of those questioned thought that it was themselves that become resistant and not the bacteria. As such, they saw it as their choice if they took that risk. They were not aware of the impact that overuse of antibiotics could have on others within the community, and that in time without careful stewardship, we may return to a time similar to that experienced before the widespread advent of antibiotics. Most had no concept of the idea of sanatoria and isolation for those with TB or that relatively simple infections could lead to amputations etc. Most were aware of the odd case of infections that had hit the headlines but had not really understood the significance of these infections where no antibiotic in the current arsenal would be effective at treating it. In summary from asking about their perception and knowledge of antibiotics, it became clear that there is a need for education of the public. However, this education needs to be simple, clear but most of all consistent! There was concern that one medical body says one thing but another part of the health service may something else, especially regarding dental health as mentioned above. If the dentist won t give an antibiotic then they will try the doctor, or vice versa. If a patient is motivated to learn more, often the guidelines that they come across don t give a consistent message for health professionals either, so it is important when developing guidance that they are consistent. I have seen 2

3 this myself with differences between guidance that has come out from various different health bodies, e.g. SIGN and NICE, Cardiac guidance etc. Thus, where possible consistency would help the public to understand the issues. So, what could be done to help improve the awareness of the public and to reduce the demand for antibiotics? In the past, before the advent of the NHS in 1948, people were prepared to wait to see if their illness was self-limiting rather than pay the cost of a doctor, which was beyond the reach of many of the population. However, often minor illnesses were self-limiting so educating the public to potentially wait 24hrs if they have toothache or a cold might help. This has to be balanced with the fact that there have been very successful and necessary high profile campaigns regarding infections such as meningitis where it is imperative that medical assistance is sought rapidly. Thus, the message needs to be along the lines of if your gut instinct tells you that you are seriously unwell, then seek medical advice. However, if you have a cold and are not coughing up green or yellow gunge, then it is likely to be viral and that antibiotics are likely to be ineffective. Also most people didn t seem to know the old wives tale about how long a cold is likely to last i.e. the 3 days getting it, 3 days having it and 3 days getting rid of it. There are also many old fashioned remedies that had some basis in truth, although there were also lots that had no discernible benefit and some of which could be dangerous. Thus, selective education regarding home remedies that do help could be an advantage. With regards to the issue of resistance, on discussion virtually everyone I questioned stated that if it was explained that although it might not affect them at that time, if antibiotics continue to be overused or used inappropriately then it will be their neighbour with leukaemia or their child with complications from chicken pox, or their parent with pneumonia who will be affected and where antibiotics will be ineffective. All those I asked stated that the message needed to be personal and reasonably hard hitting- several mentioned the tombstone adverts of the 1980 s relating to AIDS and how these had hit home and affected behaviours as well as providing education to the public. Several stated the Don t die of ignorance message so with the right approach, these levels of public education can be very effective. I am not advocating that we scare the population witless, but I am saying that all of those I questioned saw that this was an issue where the public need to be more aware, and that it should raise the issue of consequences, especially for 3

4 those close to you if you use them inappropriately or don t finish the course. With regards to finishing the course of antibiotics, many were confused by the different lengths of courses of antibiotics and it was a concern especially for the older ones I asked that the length of treatment had decreased from potentially 7 days to say 3. They were worried that they were not being adequately treated and that the infection would return with a vengeance. It may take a few extra seconds to explain regarding the reduction in length of treatment but this reassurance is vital if the public are going to work with the medical profession to reduce the number of antibiotics in use, and not immediately seek further treatment, Several mentioned the issue of delaying treatment and the risk of serious infections taking hold. There was an awareness of medical negligence and with the prevalence of no win-no fee litigation, several were conscious of the potential for increased numbers of claims if antibiotics were reduced. This could be minimised with time being spent explaining why an antibiotic is not appropriate at that moment but being advised to seek treatment again in a few days time if the condition hasn t improved. Because of this lack of understanding about how the body fights infection itself, many saw it as a time saving exercise to just demand the antibiotic, time saving not just for themselves but also for the over pushed doctor, usually the GP. They could see though that often the surgeries have a number patients taking appointments for minor infections or for things that were likely to be self limiting if given even 24 hours. On explanation, many were prepared to wait 24 hours to see if they actually needed treatment, but only with the reassurance that they could access treatment quickly if they did need it. This has been an interesting exercise for me and has demonstrated to me that many of the public have no idea how their bodies fight infection and how antibiotics work. It may be that sections on programmes such as Embarrassing Bodies or the modern equivalent of Tomorrow s World etc need to focus on areas like this. Programmes like Horizon that have done some work on how the body works are seen as too intellectual and not the way to get the message to the wider public. Now that the NHS has its own TV channel, perhaps this is an area that could be explored? What is clear is that the public need to know more- they need to know where to use these precious commodities and when to wait. They also need to know where scarce resources are best focussed. If something like Tamiflu for influenza, a virus, only reduces the impact of flu by 0.6 days, is supplying large numbers of the population a good use of resources, 4

5 especially in these days of austerity. We have to accept that at times we will be unwell. It is inconvenient, a nuisance and a pain when we all have busy lives and lots of commitments. However, perhaps we should take heed of some of the methods taken in the past and if unwell then take the time to spend a couple of days in bed, lots of fluids and rest. Then if we still need it, more active treatment. This has to be a partnership though and that does mean more time explaining why to wait, and being able to access help if necessary without a long wait. Thank you for listening 5