Case study #18: Achieving more through public involvement in antimicrobial stewardship

 

In conversation with: Dr Monsey McLeod, Lead Pharmacist Medication Safety and Anti-infectives Research and Dr Anne Campbell, Research Associate at National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London.


What did you do?

Antimicrobial resistance is a key threat to patient safety and a major driver is antibiotic use. In the UK, general practitioners (GPs) prescribe approximately 75% of all antibiotics. Under 20% of these prescriptions will benefit patients, but they all increase the number of microbes that are resistant to antibiotics, and can cause side-effects.  However, the problem is not lack of effective interventions for general practice, but the lack of uptake and sustainability of these interventions in practice.

This work focused on finding ways to improve general practice staff’s communication skills and use of interventions that has been found to be effective in clinical trials (back-up/delayed antibiotic prescriptions and point-of-care tests) but are underused in clinical practice.
We wanted to ensure that the implementation support materials would highlight important key messages and actions that would also be helpful to patients as well as to practice staff.  We conducted a workshop with 14 members of the public to develop the content for the support materials as part of the ‘Improving the uptake and SusTainability of Effective interventions to promote Prudent antibiotic Use in Primary care’ (STEP-UP) project led by Imperial College London and the University of Oxford.

We also had a lay partner in the research team who provided invaluable contributions to designing the structure and format of the workshop, as well as suggestions for maximising recruitment.

What were you trying to achieve?

By involving a group of the people working in an open, collaborative environment, our approach has helped us to garner a wide range of perspectives and experiences that we hope will increase the usability and acceptability of the intervention support materials.

Who did you involve and how did you find the right people?

We used the NIHR Involve ‘People in Research’ facility and social media to recruit people.

Were the people you involved given any training?

The public were not given any training, but we provided information around participation before the workshop and the research team was on hand to support them on the day.

Did you achieve what you set out to do?

Yes. We were pleasantly surprised by the enthusiastic, constructive and inclusive discussions, despite various opposing opinions being expressed, and the group was able to come to some very helpful agreement on potential next steps.  This led to considerable changes being made to the support materials, which we intend to present to the group at an upcoming second workshop.

What impact did the Public Involvement and/or Engagement have on the people?

We received a lot of positive feedback from the public in the workshop. Some mentioned that they now have a greater appreciation of the challenges of using antibiotics effectively in primary care.  This was particularly evident during the group discussions when they tried to identify key messages that should be communicated during the short consultation time, when there are limited diagnostic tests. They discussed how these messages should be tailored to different patients’ needs at that point in time. Some people were surprised by the complexity of communicating effectively and explaining how to use back-up/delayed antibiotic prescription. Overall, the researchers and public felt the workshop went well and was enjoyed by all.  As an interdisciplinary group of researchers, some of our team had not worked with the public in this way before and were impressed by the added-value from involving people in our research.

What was the most challenging part of doing Public Involvement and how did you overcome it?

The most challenging aspect was probably steering the group discussions so that everyone was given an opportunity to contribute and discussions stayed on track (despite many other interesting points being made and some personal experiences being shared).  We were able to overcome this partly because the research team were experienced in facilitating discussions. Also, we had set ground rules at the start of the workshop about encouraging and valuing all opinions. We also provided paper handouts to people with the main questions being discussed in the workshop so that they could add/expand on their thoughts if they so wished.

What advice would you give others interested in doing something like this?

Be sure to include lay partners and those with PPI experience in the planning of such an event as they will give invaluable advice on the wording of advertisements and information sheets, the timing of advertisements, and how such events should be facilitated.

We were well supported by our PPIE Manager from the Imperial Patient Safety Translational Research Centre, who really helped to a) make a difference in the way we structured the workshop, b) set a friendly open environment by laying some ground rules.

We also couldn’t have coordinated the day as effectively without the help of our Unit’s administrator who organised much of the communications with people before, during and after the workshop.

So, what’s next?

The same public were invited to attend a follow-up workshop to review the next draft of the intervention materials (outside of the present BRC PPI grant).  This proved to be another successful workshop and was valued as people could see how we took their previous comments on board in the revised support materials.

The format and structure of the second workshop was similar to the first, as feedback from the public suggests they were happy with the approach we took.  We will now continue to work with our lay partner to finalise the implementation support materials which we plan to provide to staff at eight general practices as part of the wider STEP-UP study and evaluate its use and effectiveness in an implementation study due to begin at the end of 2019.

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