More Than 20 Seconds: An Intervention for Antibiotic Stewardship
Antibiotics, which were once a revolution in public health, is transforming into one of its biggest threats. The CDC estimates that as much as 50% of the time, antibiotics are prescribed unnecessarily or are misused. This contributes to antibiotic-resistant bacteria which infects at least 2 million and kills 23,000 people a year, a number that is expected to rise.
Sinus infections, strep throat, tuberculosis, and scarlet fever are a few of the bacterial infections that we typically treat with a regimen of antibiotics. Antibiotics Awareness Week falls in early November as a reminder that while antibiotics save lives, antibiotic stewardship, or prescribing them correctly, ensures that they will work in the future.
Now with the weather turning colder and winter approaching, the number of patients expecting antibiotics for colds and flu increases dramatically, which provides health professionals with opportunities to educate their patient population so they understand why antibiotics are harmful for treating viral infections.
Overall Satisfaction with Episodes of Care
A condition like the common cold does not require antibiotics because it is mostly viral. But, a recent study shows that physicians are prescribing antibiotics for respiratory tract infections at twice that rate that is considered clinically appropriate. And, this prescription transaction is probably happening in 20 seconds or less.
How come? A study published this month found that patients are happiest with their doctor’s visit when they got an antibiotic after seeking care for a respiratory tract infection, (like a common cold) whether they needed the drug or not.
Recent research has underscored the importance of collaborative patient-physician communication to address this problem. However, most patients and physicians do not feel prepared to engage in such challenging conversations.
The Patient-Provider Conversation
No other factor was as strongly associated with patient satisfaction as whether they received a prescription for an antibiotic. That means that it is incentivizing physicians to make decisions that are not medically necessary. The same may even be true for patients with opioid addiction, requesting painkillers.
Another reason why physicians overprescribe antibiotics? It’s easier to say yes than no. A finding in this study says it’s easier to write a prescription as opposed to explaining to a patient why they don’t need an antibiotic. And, with physicians pressed for time to cover everything in a 15-minute appointment, researchers found it takes physicians about 20 seconds or fewer per encounter to prescribe an antibiotic. That’s less time than it took you to read to this paragraph.
Improving Antibiotic Stewardship in Primary Care Settings
Overprescribing antibiotics contributes to antimicrobial resistance, which makes them completely ineffective. This has consequences like infections that are harder to treat, leading to more morbidity and mortality and higher costs to the healthcare system.
A pilot study by the NYU School of Medicine with 35 physicians and 34 patients shows that one month after completing a 30-minute role-play simulation with virtual patients, 77% of physicians said it had a positive influence on the way they have been working with patients, and 79% of patients who saw their doctor after completing the simulation said it helped them in talking with their doctor.
What was the simulation from the study? Kognito’s Primary Care Office Visit: Antibiotics, developed in collaboration with the Robert Wood Johnson Foundation. An important topic within the simulation is antibiotic stewardship. The simulation allows providers to learn more about patient expectations about antibiotics and how to explore those expectations, as well as better techniques for educating patients about antibiotics.
There is also a version of the simulation for patients that empowers them to be part of this decisionmaking. These activated patients become familiar with the risks posed by inappropriate antibiotic prescription, as well as when it is appropriate and inappropriate to ask for antibiotics.
Primary care providers can test their knowledge, role-play with a virtual patient, and see if their visit was successful by completing the simulation here. For Antibiotics Awareness Week, we hope you’ll share this resource to maintain patient satisfaction, thwart public health concerns in the future, and ultimately save lives.