Evaluation of a national programme to reduce inappropriate use of antibiotics for upper respiratory tract infections: effects on consumer awareness, beliefs, attitudes and behaviour in Australia

Abstract

The over-use of antibiotics, in particular, inappropriate use to treat upper respiratory tract infections (URTIs), is a global public health concern. In an attempt to reduce inappropriate use of antibiotics for URTIs, and, in particular, to modify patient misconceptions about the effectiveness of antibiotics for URTIs, Australia's National Prescribing Service Ltd (NPS) has undertaken a comprehensive, multistrategic programme for health professionals and the community. Targeted strategies for the community, via the NPS common colds community campaign, commenced in 2000 and have been repeated annually during the winter months. Community strategies were closely integrated, using the same tagline, key messages and visual images, and were delivered in numerous settings including general practice, community pharmacy, child-care centres and community groups. Strategies included written information via newsletters and brochures, mass media activity using billboards, television, radio and magazines and small grants to promote local community education. The evaluation used multiple methods and data sources to measure process, impact and outcomes. Consistent with intervention messages, the integrated nationwide prescriber and consumer programme is associated with modest but consistent positive changes in consumer awareness, beliefs, attitudes and behaviour to the appropriate use of antibiotics for URTIs. These positive changes among the community are corroborated by a national decline in total antibiotic prescriptions dispensed in the community (from 23.08 million prescriptions in 1998-99 to 21.44 million in 2001-02) and, specifically, by a decline among the nine antibiotics commonly used for URTI such that by 2003 nationally 216,000 fewer prescriptions for URTI are written each year by general practitioners.

Public Knowledge and Attitudes Regarding Antibiotic Use in South Korea

“…The benefits of public campaigns present slowly over time, suggesting the need for continual reinforcement and repetition (Wutzke et al, 2006). Strategies including use of television, newspapers, and the internet are effective modalities for public education, considering transferring time zone (Finch, Metlay, Davey, & Baker, 2004;Madle, Kostkova, Mani-Saada, Weinberg, & Williams, 2004).…”

“…Repeated information using short, tailored slogans and cues to action would improve general knowledge on antibiotics, especially in groups with lower educational levels (Marx, Nedelmann, Haertle, Dieterich, & Eicke, 2008). Furthermore, if the aim is to reduce antibiotic use for URIs, then public education would work best when aligned with interventions aimed at physicians (Kiang et al, 2005;Wutzke et al, 2006). Educational campaigns including physicians have had a positive effect on knowledge and a reduction in the prescription of antibiotics (Kiang et al; Wutzke et al).…”

“…It would be a campaign addressing the fact that antibiotics do not cure common coughs or colds. Several countries have undertaken national campaigns to modify the public's misconceptions regarding the effectiveness of antibiotics, to promote appropriate antibiotic use and prevent the development of antibiotic resistance (Andre, Vernby, Berg, & Lundborg, 2010;Curry et al, 2006;McNulty, Boyle, Nichols, Clappison, & Davey, 2007a;Woodhead & Finch, 2007;Wutzke et al, 2006). Korea had the sixth highest antibiotic usage in OECD countries according to 2003 health insurance claim data in Korea .…”

Exploring the evidence base for national and regional policy interventions to combat resistance

“…[19][20][21][22] Most campaigns show around 10% reductions in prescriptions and appear effective only in the short-run. 23,24 Multi-faceted campaigns that target both prescribers and consumers appear to yield better results than more narrowly designed interventions. 25 Amongst the most promising policy options in primary care is "backup/ delayed prescribing" which describes interventions that create a delay for patients between prescription and the collection of antimicrobials for infections.…”

“…45 An evaluation of EAAD effectiveness in the UK for instance concluded that the campaign had only led to a minimal increase in public awareness, with no observable reduction in antibiotic use. 46 However, long-running campaigns, especially in Australia and France, have been associated with modest but consistent improvements in consumer awareness, as well as a reduction in antibiotic prescribing.. 47,24 What has proved to be particularly challenging is communicating the differences between bacterial and viral infections. 30,48 Case study 1: The physican and patient perspective -how failure to engage the private sector in AMR control can impact health A 43-year old male patient with a past history of tuberculosis infection presented at a tertiary care centre in Karachi, Pakistan, with a one-month history of hemoptysis, fever and weight loss.…”