Resumen de Primary care pharmacist community intervention on prudent use of antibiotics
Mª Carmen Herrero Domínguez-Berrueta, Eva Prieto Utiel, Ana Gangoso Fermoso, Blanca Basagoiti Carreño, Ana Díez Alcántara, María José Almodóvar Carretón, Antonio Martín Alonso
Introduction: Multiple factors may influence on the increase of bacterial resistance to antimicrobials: excessive and inadequate use of antibiotics, lack of awareness of the correct use of antibiotics, the importance of prevention of infection, or the limited involvement of patients. In different areas, the Rational Use of Antibiotics Programs aim to raise public awareness of the need for prudent use of antimicrobials. An aware- ness-raising activity in primary health-care centers is being carried out by Primary Care Pharmacists (PCP), with the main objective of understanding the degree of knowledge improvement of users, on the risks associated with antibiotic abuse.
Method: Cross-sectional pre and post-test intra-subject intervention study. Inclusion criteria: citizens interested in participating by attending the selected primary health-care centres. Exclusion criteria: citizens with linguistic difficulties and/or unable to answer the questions in the survey, or who do not complete the two questionnaires (pre- and post---intervention). The community intervention was carried out in two complementary and sequential activities: an awareness-raising table to carry out the pre-intervention survey validated in the official National Plan against Antibiotic Resistance (PRAN) campaign, and dissemination of European Centre for Disease Prevention and Control (ECDC) official outreach materials. The second activity was the display of audio-visual material from validated scientific sources and the completion of the post-intervention survey. After the completion of the activities, citizens answered a utility questionnaire.
Results: 138 citizens were surveyed in five primary health-care centers [68.8% women; median age (IQR): 52 (28); 56.5% with university education]. The average number of successful cases in the pre-intervention survey was 3.41 (95% CI: 3.24- 3.59) and in the post-intervention survey 4.35 (95% CI: 4.19-4.51). After the intervention, an improvement was observed in the post-test (considering improvement: at least one more point, compared to the score obtained in the pre-intervention sur- vey) in 90 citizens (65.2%); 7 (5.1%) subjects worsened their score; and 41 (29.7%) achieved the same pre- and post-intervention successes, although of these, 13 had obtained the maximum score of 5/5. Those having lower level of studies achieved a higher degree of improvement (mean difference in pre/post score of 1.75 points and 1.65 points; in the group «without studies» and «primary studies» respectively), than the subjects with a higher level of education (mean difference in pre/post score of 0.70 points and 0.81; in the «secondary studies» and «university studies» group respectively). 79 (57.2%) subjects responded that the intervention was «very useful» and 54 (39.1%) «Useful». 96.4% would recommend it to other citizens.
Discussion: These types of community interventions can be led by the PCP, which, as a health agent in primary health-care centers and connoisseur of the drug, can act proactively by collaborating in targeted public awareness campaigns. The results obtained in this study show that these are interventions that are useful for the population, and that they can achieve good results in perceptions of the responsible use of antibiotics, especially in those patients with lower level of knowledge
