Volume 202 - Issue 4
Antibiotic prescribing in residential aged care facilities — health care providers' perspectives
Author: Georgina Kilroy
Med J Aust 2015; 202 (4): 179-180. || doi: 10.5694/mja14.01299
Published online: 2 March 2015
Published online: 2 March 2015
Consumers can play a major part in antimicrobial stewardship
To the Editor: I was interested to gain some insight into the drivers of antibiotic prescribing in Australian residential aged care facilities (RACFs).1 I was surprised, though, that Lim and colleagues did not include residents or their families in consultations, opting to focus solely on the perspectives of health care providers.
It is apparent that consumers have a key role to play in antimicrobial stewardship initiatives;2 expectations of consumers are often identified by clinicians as a contributing factor in inappropriate antimicrobial prescribing in primary care. It should not have come as a surprise that the impact of patients and their families emerged as a recurring theme in responses from general practitioners and nurses in the study (see Box 4), with the discussion citing pressure from family as having a “significant influence”.1 It has been shown, however, that it is not only patients' views, but clinicians' perceptions of these views, that influence prescribing decisions.3-5
Recommendations made in the discussion to overcome the impact of patient or family pressures are at risk of being ineffective in the absence of consumer consultation. Recognition of these limitations, and comment on opportunities for further research, were notably absent in this article. I implore the authors to consider consumers a central component of any further work in this area. RACFs should not be exempt from the move towards patient-centred care and shared decision making, both of which are very much entwined in workplace culture.
Competing interests
The views expressed in this letter are mine and do not necessarily represent those of Therapeutic Guidelines Limited.
References
- Lim CJ, Kwong MW-L, Stuart RL, et al. Antibiotic prescribing practice in residential aged care facilities — health care providers' perspectives. Med J Aust 2014; 201: 101-105. 1
- McKenzie D, Rawlins M, Del Mar C. Antibiotic stewardship: what's it all about? Aust Prescr 2013; 36: 116-120. 2
- Mustafa M, Wood F, Butler CC, Elwyn G. Managing expectations of antibiotics for upper respiratory tract infections: a qualitative study. Ann Fam Med 2014; 12: 29-36. 3
- Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations — a questionnaire study. BMJ 1997; 315: 520-523. 4
- Coenen S, Francis N, Kelly M, et al. Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough. PLOS One 2013; 8: e76691. lefthere