D3-P3- A Study on the Relationship Between Improved Patient Knowledge & Compliance With Antibiotic...

8/13/2019 D3-P3- A Study on the Relationship Between Improved Patient Knowledge & Compliance With Antibiotic Use

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A study on the relationshipbetween improved patientknowledge andcompliance with antibiotic

use

Cathar ina Colette Beukes

Supervisor: Professor A.G.S. Gous


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Background:

Antibiotic resistance is fast becoming amajor health challenge. Patients need

to be educated on the origin of thismedical crisis and need to changetheir attitude toward antibiotic use.

Health professionals need to helppatients improve antibiotic complianceand identify problem areas.


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Objectives:

The aim of this study was to determine whether abetter understanding of resistance formation andpatient education on responsible use of antibioticswill improve patient compliance towards antibioticuse.

To achieve the aim of the study: Determined the patients compliance on antibiotic use by

the self-pill count feedback method. Determined whether the provision of more antibiotic

information to the patient correlated to better complianceand

Other reasons for non-compliance were also recorded. Compared the findings of the study with other similar

antibiotic compliance studies.


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Methodology:

The study was conducted at a privatehospital in Gauteng. Patients receivingantibiotic prescriptions were divided into

two groups. Group A received a leaflet withtheir antibiotic prescription with informationon how to use antibiotics responsibly. GroupB did not receive any additional informationon antibiotic use. Both these groups werecontacted via e-mail and asked to completea survey to test their knowledge andattitude towards antibiotics.


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Antibiotics: Wise-up and take responsibility Antibiotics are the first line of defence against many infections, however, overusing or misusing antibiotics can cause treatment failure in

future.

What are antibiotics?

Antibiotics are used for treating many less serious to life-threatening diseases caused by bacterial infections. Taking antibiotics when youdon't need to, can lead to antibiotic-resistance. Antibiotics are only effective against bacterial infections, certain fungal infections and somekinds of parasites. Most infections result from either bacteria or viruses. Antibiotics are not effective against viral infections!

Common bacterial infections cause severe upper-respiratory-tract infections e.g. pneumonia, wound and skin infections and urinary tractinfections.

Common colds, influenza, most ear infections and stomach flu are caused by viral infections. These can be treated by anti-viral drugs or

by treating the symptoms.

How does antibiotic resistance develop?

Penicillin was introduced in the first part of the 20th century and since then scientists have developed many more antibiotics to help stopthe spread of infectious disease. Antibiotics have saved millions of lives but because of frequent use, often for conditions or infections thataren't caused by bacteria, the bacteria have become resistant to many commonly used antibiotics.Resistance develops when an antibiotic fails to kill all of the bacteria it targets. The surviving bacteria adapt and become more resistant tothat particular drug. Doctors then needs to prescribe stronger antibiotics, but the bacteria quickly learn to defend themselves against themore potent drugs as well, creating a cycle in which increasingly powerful drugs are required to treat infections.Experts are working to develop new antibiotics and to keep pace with antibiotic-resistant strains of bacteria, but bacteria adapt quickly.

Antibiotic-resistant bacteria continue to be a global health concern and using antibiotics wisely is an important part of preventing thedevelopment of resistance.

Consequences of antibiotic resistance

As an increasing amount of bacteria become resistant to first line treatments, the consequences become severe. Illnesses last longer, andthe risk of complications and death increases. The inability to properly treat a particular infection leads to longer periods in which aperson is contagious and able to spread the resistant bacterial strains to others.Because of first line treatment failures, doctors have to resort to less-conventional antibiotics, many of which are much more costly andhave more side-effects.Many other factors need to be considered, including the increased costs associated with prolonged illnesses, direct expense for additionallaboratory tests, treatments and hospitalization, and the indirect costs from loss of income or time away from family.

Safeguard effective antibiotics: What you can do

Finishing your prescribed course of antibiotics is utmost importance.

Using antibiotics too often or incorrectly is a major cause of the increase in resistant bacteria. Here are some things you can do topromote proper use of antibiotics:

Understand when antibiotics should be used.Don't expect to take antibiotics every time you're sick. Antibiotics are effective in

treating bacterial infections, but they're not useful against viral infections, such as colds, acute bronchitis, or the flu. And even somecommon minor bacterial ailments, such as mild ear infections, don't benefit much from antibiotics.

Don't pressure your doctor for antibiotics if you have a viral illness. Talk to your doctor about ways to relieve the symptoms ofyour viral infection.

Take antibiotics exactly as prescribed.Follow your doctor's instructions when taking prescribed medication, including how manytimes a day and for how long. Never stop treatment a few days early if you start feeling better a complete course of antibiotics isneeded to kill all of the harmful bacteria. A shortened course of antibiotics often only kills the most vulnerable bacteria, while allowingrelatively resistant bacteria to survive.

Never take antibiotics without a prescription. You might be tempted to use leftover medication the next time you get sick. Thismight be the incorrect antibiotic for you infection and an incomplete course.

Protect yourself from infection in the first place.Good hygiene can go a long way in preventing infection. Wash your handsthoroughly with soap and water, especially after using the toilet, changing a diaper or handling raw meat or poultry. Keep foodpreparation areas clean.

Antibiotic resistance is a pressing, global health problem. Nearly all bacterial infections are becoming resistant to commonly usedantibiotics. When you abuse antibiotics, the resistant micro-organisms that you help create can cause new and hard-to-treat infections.That's why the decisions you make about antibiotic useunlike almost any other medicine you takeextend far beyond your reach.Responsible antibiotic use protects the health of your family, neighbours and ultimately the global community.


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Dear Pretoria East Hospital Pharmacy Patient,

We would like to follow-up on the use of your antibiotics received at

our pharmacy on ________. A questionnaire survey has beencompiled to measure patients adherence to antibiotic prescriptioninstructions and also the information received from the pharmacist orassistant that issued your prescribed antibiotics.

We would appreciate it if you could take 3 minutes to answer the 11questions. This survey aims to determine how we can improve ourservice to patients and ensure that patients receive the necessary

information regarding the medication they need to take.

All patient information will be kept confidential and will only be usedfor the purposes of the study. No names are asked in thisquestionnaire and all data will be saved anonymously.

Your consent to partake in this study will be given by completing the

questionnaire below and returning it to the sender. Your participationwould be greatly appreciated.

Please first answer the questions, next 'copy' the text with the givenanswers. Click on the reply button, then 'paste' thecompleted questionnaire before clicking on the send button.


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1. Have you finished you antibiotic course?YesNo

If you answered 'No', please specify how many of the tablets or how much of thesuspension do you have left over?

2. Did you finish the antibiotics in the prescribed time?YesNo

3. The following might be possible reasons for not finishing theprescribed antibiotics. Choose the most appropriate option.

You felt better before the antibiotic course was finishedThe antibiotics made you feel worseThe antibiotic course was too longYou did not know for how long to take your antibioticsYou did not receive the whole antibiotic courseYou had trouble taking the antibiotics because of tablet size or flavourYou forgot to take the antibioticOther reasons or when answeringYesto question 1.Please explain when choosing 'Other reasons':

4. Do you know what happens when one does not finish acourse of antibiotics?Yes

NoIf your answer is 'Yes', what do you think would happen?


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5. What have you done with left-over antibiotics in the past?Kept it for future useThrew it awayGave it to someone that needed antibiotics6. What would you do with left-over antibiotics in future?

7. Would you ask your doctor for antibiotics when you have acommon cold?YesNoHave you asked your doctor for antibiotics when having a common cold in thepast?

8. Did you receive an 'Antibiotics: wise-up and take responsibility'brochure from your pharmacist?

Did you read the brochure? (answer from drop-down menu)YesNo9. What is the most important lesson you learned by reading the

'Antibiotics: wise-up and take responsibility' brochure?

10. In what way would you change your use of antibiotics, if youwould change anything?

11. Would you prefer to receive more information on responsibleantibiotic use?

YesNo


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Results:


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274Patients

138Received additional

antibiotic information

136Received no

additional antibioticinformation

39 responses=

39 participants99 no response

40 responses=

40 participants96 no response

32 read theadditional information

=Group Aa

7 did not read theadditional

information=Group Ab

40 did not receiveadditional information

=Group B

24 adult participants8 child participants



71 adult patients28 child patients

71 adult patients25 child patients

Participant response rate


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A total of 79 patients participatedin the study. Group A with 39

participants and Group B with 40participants completed thequestionnaire and reported on

their antibiotic usage andknowledge


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0

2

4

6

8

10

12

14

%o

fpatientprescriptio

ns

0-14y

ears

15-19

year

s

20-29

year

s

30-39

year

s

40-49

year

s

50-59

year

s

60-69

year

s

70-79

year

s

80-89

year

s

Age group

Male

Female

Patient age distribution


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1. Have you finished your antibioticcourse?


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Question Sample(N) 79 Yes % No % Grouptotal

1. Have you

finishedyour

antibiotic

course?

Group

Aa31 96.88% 1 3.12% 32

(100%)Group

Ab 5 71.43% 2 28.57% 7 (100%)Group B 34 85% 6 15% 40

(100%)Total 70 88.61% 9 11.39% 79

(100%)

Group Aa, who was provided additional

information on antibiotic use and readthrough the brochure, showed a bettercompliance to the antibiotic regimen

prescribed.


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2. Did you complete the antibiotics in

the prescribed time?


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Question Sample(N) 79 Yes % No % Grouptotal

2. Did you

complete theantibiotics in

the

prescribed

time?

Group

Aa30 93.75% 2 6.25% 32

(100%)Group

Ab 5 71.43% 2 28.87% 7 (100%)Group B 33 82.50% 7 17.50% 40

(100%)Total 68 86.08% 11 13.92% 79

(100%)


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3: The following might be possible reasons for notfinishing the prescribed antibiotics. Choose themost appropriate option.

You felt better before the antibiotic course was finished 5 31%

The antibiotics made you feel worse 1 6%

The antibiotic course was too long 3 19%

You did not know for how long to take your antibiotics 0 0%

You did not receive the whole antibiotic course 0 0%

You had trouble taking the antibiotics because of tablet size 1 6%

You forgot to take the antibiotic 3 19%

Other reasons or when answering Yes to question 1. 3 19%

N = 16 100%


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6%19%

19% 6%

19%31%

The patient felt better before the

antibiotic course was finished

The antibiotics made the patient feel

wose

The antibiotic course was too long

The patient had trouble taking theantibiotics because of tablet size or

flavourThe patient forgot to take the antibiotic

Other reasons

Reportedreasons for patient non-compliance


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Participants gave various reasonsfor not being compliant. Most

patients stopped taking theirantibiotics as soon as they feltbetter.


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4: Do you know what happenswhen one does not finish a course

of antibiotics? What do you thinkwill happen?


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79 Participants

58Participants

Know whyone completeantibiotics73.42%

18Antibioticswill stopworking

21Participants

Dont know

why onecompleteantibiotics

26.58%

18Participant

s

Group B

3Participants

:

Group Ab

1Patient willbecomeimmuneto the

antibiotic

5No answer

15The

infectionwill notclear up

19Resistancewill develop


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79 Participants

58 Participants

Know why one completeantibiotics73.42%


12Group Aa

21 Participants

Dont know why onecomplete antibiotics

26.58%

18Participants

Group B

3Participants:

Group Ab

1Patient will

become immuneto the antibiotic

5No answer

15The infection

will notclear up


5Group B

1Group Ab

13Group Aa

5Group B

1Group Ab

4Group Aa

9Group B

2Group Ab

3Group Aa

2Group B

0Group Ab

0Group Aa

1Group B

0Group Ab

73.42% 26.58%


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79 Participants

58 Participants

Know why one completeantibiotics73.42%


31.03%

12Group Aa

66.67%

21 Participants

Dont know why onecomplete antibiotics

26.58%

18Participants

Group B85.71%

3Participants:

Group Ab14.29%

1Patient will


1.72%

5No answer

8.62%

15The infection

will notclear up

25.86%


32.76%

5Group B

27.77%

1Group Ab

5.56%

13Group Aa

68.84%

5Group B

26.31%

1Group Ab

5.26%

4Group Aa

26.67%

9Group B

60%

2Group Ab

13.33%

3Group Aa

60%

2Group B

40%

0Group Ab

0%

0Group Aa

0%

1Group B

100%

0Group Ab

1%

73.42% 26.58%


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79 Participants

58 ParticipantsKnow why one

completeantibiotics73.42%

18Antibioticswill stopworking31.03%

12Group Aa

66.67%

21 ParticipantsDont know why

one completeantibiotics

26.58%

18Participants

Group B85.71%

3Participants:

Group Ab14.29%

1Patient will


1.72%

5No answer

8.62%

15The infection

will notclear up

25.86%


32.76%

5Group B

27.77%

1Group Ab

5.56%

13Group Aa

68.84%

5Group B

26.31%

1Group Ab

5.26%

4Group Aa

26.67%

9Group B

60%

2Group Ab

13.33%

3Group Aa

60%

2Group B

40%

0Group Ab

0%

0Group Aa

0%

1Group B

100%

0Group Ab

1%

73.42% 26.58%


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When compared to Group Ab, whoreceived additional information onantibiotic use and did not read

through the brochure, and GroupB, who received no additionalinformation on antibiotic use, amuch higher percentage of Group

Aa was able to give valid reasonsas to why one should complete anantibiotic course.


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5: What have you done with left-over antibiotics in the past?

Kept it for future use

Threw it away

Gave it to someone that needed antibiotics

6. What would you do withleft-over antibiotics in future?


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Participants kept left-over antibiotics for future use

Patientskept

left-overantibiotics

forfuture use

n=19

9Patientsreceived

a brochureand

read theleafletGroup

Aa

3Patients receiveda brochure butdid not readthe leaflet

GroupAb

7Patients did not

receive aleaflet

Group B

2patients will

throw awaytheir

left-overantibioticsin future

7 patientswill completetheir antibiotic

courses infuture

1 patientwill complete

theantibioticcourse in

future

6 patients willstill keep their


for future use



for future use

1 patient willthrow away the

left-overantibioticsin future

Futurebehaviour

Futurebehaviour

Past behaviour

Futurebehaviour


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Patients keptleft-over

antibiotics forfuture use

n=19

9Patients receiveda brochure andread the leaflet

Group Aa

3Patients received a

brochure butdid not readthe leafletGroup Ab

7Patients did not

receive aleaflet

Group B

2patients willthrow away their

left-over antibioticsin future


courses in future

1 patientwill complete theantibiotic course

in future


left-over antibiotics

for future use



for future use



in future

77.78%+ve

change inbehaviour

n=7

0%+ve

change inbehaviour

n=0

14.29%+ve

change inbehaviour

n=1

Futurebehaviour

Futurebehaviour

Past behaviour

Futurebehaviour


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Patients keptleft-over

antibiotics forfuture use

n=19

9Patients receiveda brochure andread the leaflet

Group Aa

3Patients received a

brochure butdid not readthe leafletGroup Ab

7Patients did not

receive aleaflet

Group B

2patients willthrow away their

left-over antibioticsin future


courses in future

1 patientwill complete theantibiotic course

in future



for future use



for future use



in future

77.78%+ve

change inbehaviour

n=7

0%+ve

change inbehaviour

n=0

14.29%+ve

change inbehaviour

n=1

Futurebehaviour

Futurebehaviour

Past behaviour

Futurebehaviour


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Participants threw away left-over antibiotics

Participantsthrew awayleft-overantibiotic

49

17Participansreceived a

leaflet

Group Aa

4Participantreceived a

leaflet but did notread the leaflet

Group Ab

28Participantsreceived no

leafletGroup B

12 participantswill complete theantibiotic course

in future

5 participantswill throw away


4 Participantswill throw away


2 Participantswill complete theantibiotic course

in future

26 Participantswill throw away

left-overantibiotic

Past behaviour

Future behaviour Future behaviour


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Participantsthrew away left-over antibiotic

49


leaflet

Group Aa



Group Ab


leafletGroup B

12 participants willcomplete the

antibiotic course infuture

5 participants willthrow away left-over antibiotics

70.59%+vechange inbehaviour

n=12

4 Participants willthrow away left-over antibiotics

0%+ve change inbehaviour

n=0

2 Participants willcomplete the


26 Participants willthrow away left-over antibiotic


n=2

Past behaviour



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Participantsthrew away left-over antibiotic

49


leaflet

Group Aa



Group Ab


leafletGroup B

12 participants willcomplete the


5 participants willthrow away left-over antibiotics


n=12

4 Participants willthrow away left-over antibiotics

0%+ve change inbehaviour

n=0

2 Participants willcomplete the


26 Participants willthrow away left-over antibiotic


n=2

Past behaviour



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Participant will giveleft-over antibiotic tosomeone who might

need antibiotics

3

3Participants

received a leaflet

Group Aa

3Participants will complete thecourse of antibiotics in future

Participants gave left-over antibiotics to someone in need of antibiotics

Past behaviour

Future behaviour


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need antibiotics3

3Participants

received a leaflet

Group Aa


100%+ve change to

behaviour

n=3

Past behaviour

Future behaviour


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need antibiotics3

3Participants

received a leaflet

Group Aa


100%+ve change to

behaviour

n=3

Past behaviour

Future behaviour


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Participant always completethe antibiotic course with no


10

5Participants received a

leafletGroup Aa

5Participants did not receive a

leafletGroup B

5Participants will complete the

antibiotic course in future

5Participants will complete the

antibiotic course in future

100%+ve participant behaviour

100%+ve participant behaviour

Future behaviour

Participants always complete an antibiotic course


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78% of Group Aa intended tochange their future behaviour

with regards to left-overantibiotics. These patients arecommitted to being completelycompliant in future.


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7: Would you ask your doctor forantibiotics when you have acommon cold?

Yes

NoHave you asked your doctor for antibiotics when having a

common cold in the past?


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N=79 Group Past % Future %Group Aa 22/32 68.75% 32/32 100%Group Ab 4/7 57.14% 4/7 57.14%Group B 32/40 80% 32/40 80%

Participants who do not put pressure on doctors to prescribeantibiotics in viral infections


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0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Group Aa Group Ab Group B

Past

Pressure from participants to get antibiotics prescriptions for viral infections


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0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%


Past

Future



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0.00%

20.00%

40.00%

60.00%

80.00%

100.00%


Past

Future



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Group Aa showed a 100% changein attitude when it comes to

pressurizing medical practitionersinto prescribing antibiotics forminor illness, colds and flu.


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9: In what way would you change your useof antibiotics, if you would change

anything?N =32 Statement

#

Statement

15 Nr. 1 Nothing Participants did complete

course in prescribed time and

have not asked for antibiotics

from a medical practitioner

10 Nr. 2 One should always complete

the course

(1 overlap statement Nr 4 and

1 overlap with Nr 5)

2 Nr. 3 One should only use

antibiotics when it is

necessary

4 Nr. 4 One should use antibioticsfor bacterial infections and

not for viral infections

(1 overlap statement Nr 2)

2 Nr. 5 One should not pressure a

medical practitioner for an

antibiotic prescription when

having a flu

(1 overlap with statement Nr

2)

1 No answer provided


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10: What is the most important lessonyou learned by reading the

'Antibiotics: wise-up and takeresponsibility' brochure?

N

=32

Statemen

t #

Statement

12 Nr. 1 Antibiotics has no effect

on viruses and should

only be used for bacterial

infections, not colds and

flu

(1overlap with statement

Nr 2)

12 Nr. 2 All bacteria need to be

killed by the antibiotic

and the course should be

completed to reduce

antibiotic resistance


Nr 1)


Nr 3)

7 Nr. 3 One should not over use

antibiotics

(2 overlap with statement

Nr 2)

3 Nr. 4 Nothing learned1 Nr. 5 Patients will become

immune to antibiotics


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ld f


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11: Would you prefer to receive moreinformation on responsible antibiotic use?

Answer Group Gender/Age GroupFemale Male Children

Yes Group Aa 12 7 7Group Ab 1 1 3Group B 11 8 4

Total: 54

(68.35%) Total: 24(70.59%) Total: 16(64%) Total: 14(70%)No Group Aa 2 3 1

Group Ab 1 1 0Group B 7 5 5

Total: 25

(31.64%) Total: 10(29.41%) Total: 9(36%) Total: 6(30%)Total: 100% 100% 100% 100%


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