How to address vaccine hesitancy

Despite the proven efficacy of vaccines, vaccine hesitancy is a growing problem. This article highlights how pharmacists and pharmacy teams can address vaccine hesitancy and allay patient concerns in the context of COVID-19 vaccines

Training university students as vaccination champions to promote vaccination in their multiple identities and help address vaccine hesitancy

Introduction: Covid-19 related vaccine hesitancy is a major problem worldwide and it risks delaying the global effort to control the pandemic. Covid-19 vaccine hesitancy is also higher in certain communities. Given that prescriber recommendation and community engagement are two effective ways of addressing vaccine hesitancy, training university students to become vaccination champions could be a way of addressing hesitancy, as the champions engage with their communities in their multiple identities. Aim: This study aims to assess the impact of a pilot project conducted in the UCL School of Pharmacy that could pave a way of integrating vaccination championing in the pharmacy undergraduate curriculum to address vaccine hesitancy. Method: Participants completed a pre-workshop questionnaire, attended an online workshop, conducted vaccination-promoting action/s, and provided evidence via a post-workshop questionnaire. Result: Fifty three students completed the course. The students’ vaccination-promoting actions ranged from speaking with vaccine-hesitant family, friends and customers in the pharmacy, to posting on various social media platforms. Post-workshop showed an increase in the knowledge of participants regarding vaccination and a decrease in the belief of vaccine misconceptions. After attending the workshop, participants were more likely to engage with vaccine-hesitant friends, family, strangers and patients. They were also more likely to receive the Covid-19 vaccine for them and for their children

Criticality in a Hadron Resonance Gas model with the van der Waals interaction

The van der Waals interaction is implemented in a Hadron Resonance Gas model. It is shown that this model can describe Lattice QCD data of different thermodynamical quantities satisfactorily with the van der Waals parameters $a = 1250 \pm 150$ MeV fm$^3$ and $r = 0.7 \pm 0.05$ fm. Further, a phase transition is observed in this model with the critical point at temperature, $T = 62.1$ MeV and baryon chemical potential, $\mu_B = 708$ MeV

Antimicrobial Stewardship Programmes in Community Healthcare Organisations in England: A Cross-Sectional Survey to Assess Implementation of Programmes and National Toolkits

Objective: The aim of this study was to assess antimicrobial stewardship activities in Community Healthcare Organisations (CHOs) with focus on the implementation of the two national antimicrobial stewardship toolkits, TARGET (Treat Antibiotics Responsibly, Guidance, Education, Tools) and SSTF (Start Smart, then Focus). The study utilised a web-based survey comprising 34 questions concerning antimicrobial policies and awareness and implementation of antimicrobial stewardship toolkits. This was distributed to pharmacy teams in all 26 CHOs in England. Twenty CHOs (77%) responded. An antimicrobial stewardship (AMS) committee was active in 50% of CHOs; 25% employed a substantive pharmacist post and 70% had a local antibiotic policy. Fourteen of the responding CHOs were aware of both AMS toolkits, five organisations were aware of either SSTF or TARGET, and one organisation was not aware of either toolkit. Of the organisations aware of SSTF and TARGET, eight had formally reviewed both toolkits, though three had not reviewed either. Less than half of the respondents had developed local action plans for either toolkit. National guidance in England has focused attention on initiatives to improve AMS implementation in primary and secondary care; more work is required to embed AMS activities and the implementation of national AMS toolkit recommendations within CHOs.Peer reviewedFinal Published versio

Enhancing the training of community engagement officers to address vaccine hesitancy: a university and local authority collaboration

Introduction: Vaccine hesitancy/scepticism remains an issue, and ongoing actions to promote vaccination are needed. While no single intervention strategy addresses all instances of vaccine hesitancy, effective methods have been identified. For example, recommendations from a healthcare professional and dialogue-based, directly targeted approaches with personalised and tailored communications for different audiences, including from a trusted community member.1–

Impact of a United Kingdom-wide campaign to tackle antimicrobial resistance on self-reported knowledge and behaviour change

BackgroundAs part of the 2014 European Antibiotic Awareness Day plans, a new campaign called Antibiotic Guardian (AG) was launched in the United Kingdom, including an online pledge system to increase commitment from healthcare professionals and members of the public to reduce antimicrobial resistance (AMR). The aim of this evaluation was to determine the impact of the campaign on self-reported knowledge and behaviour around AMR.MethodsAn online survey was sent to 9016 Antibiotic Guardians (AGs) to assess changes in self-reported knowledge and behaviour (outcomes) following the campaign. Logistic regression models, adjusted for variables including age, sex and pledge group (pledging as member of public or as healthcare professional), were used to estimate associations between outcomes and AG characteristics.Results2478 AGs responded to the survey (27.5% response rate) of whom 1696 (68.4%)pledged as healthcare professionals and 782 (31.6%) as members of public (similar proportions to the total number of AGs). 96.3% of all AGs who responded had prior knowledge of AMR. 73.5% of participants were female and participants were most commonly between 45-54 years old. Two thirds (63.4%) of participants reported always acting according to their pledge. Members of the public were more likely to act in line with their pledge than professionals (Odds Ratio (OR) =3.60, 95% Confidence Interval (CI): 2.88-4.51). Approximately half of participants (44.5%) (both healthcare professionals and members of public) reported that they acquired more knowledge about AMR postcampaign.People that were confused about AMR prior to the campaign acquired moreknowledge after the campaign (OR=3.10, 95% CI: 1.36-7.09). More participantsreported a sense of personal responsibility towards tackling AMR post-campaign, increasing from 58.3% of participants pre-campaign to 70.5% post-campaign.ConclusionThis study demonstrated that the campaign increased commitment to tackling AMR in both healthcare professional and member of the public, increased self-reported knowledge and changed self-reported behaviour particularly among people with prior AMR awareness. Online pledge schemes can be an effective and inexpensive way to engage people with the problem of AMR especially among those with prior awareness of the topic

Trends and patterns in antibiotic prescribing among out-of-hours primary care providers in England, 2010–14

Objectives: Antimicrobial resistance is a global threat, increasing morbidity and mortality. In England, publicly funded clinical commissioning groups (CCGs) commission out-of-hours (OOH) primary care services outside daytime hours. OOH consultations represent 1% of in-hours general practice (GP) consultations. Antibiotic prescriptions increased 32% in non-GP community services between 2010 and 2013. We describe OOH antibiotic prescribing patterns and trends between 2010 and 2014. Methods: We: estimated the proportion of CCGs with OOH data available; described and compared antibiotic prescribing by volume of prescribed items, seasonality and trends in GP and OOH, using linear regression; and compared the proportion of broad-spectrum to total antibiotic prescriptions in OOHs with their respective CCGs in terms of seasonality and trends, using binomial regression. Results: Data were available for 143 of 211 (68%) CCGs. OOH antibiotic prescription volume represented 4.5%-5.4% of GP prescription volume and was stable over time ( P  =   0.37). The proportion of broad-spectrum antibiotic prescriptions increased in OOH when it increased in the CCG they operated in (regression coefficient 0.98; 95% CI 0.96-0.99). Compared with GP, the proportion of broad-spectrum antibiotic prescriptions in OOH was higher but decreased both in GP and OOH (-0.57%, 95% CI - 0.54% to - 0.6% and -0.76%, 95% CI - 0.59% to - 0.93% per year, respectively). Conclusions: OOH proportionally prescribed more antibiotics than GPs although we could not comment on prescribing appropriateness. OOH prescribing volume was stable over time, and followed GP seasonal patterns. OOH antibiotic prescribing reflected the CCGs they operated in but with relatively more broad-spectrum antibiotics than in-hours GP. Understanding factors influencing prescribing in OOH will enable the development of tailored interventions promoting optimal prescribing in this setting

Knowledge and attitudes about antibiotics and antibiotic resistance of 2404 UK healthcare workers

Background: Using the COM-B model as a framework, an EU-wide survey aimed to ascertain multidisciplinary healthcare workers’ (HCWs’) knowledge, attitudes and behaviours towards antibiotics, antibiotic use and antibiotic resistance. The UK findings are presented here. Methods: A 43-item questionnaire was developed through a two-round modified Delphi consensus process. The UK target quota was 1315 respondents. Results: In total, 2404 participants responded. The highest proportion were nursing and midwifery professionals (42%), pharmacists (23%) and medical doctors (18%). HCWs correctly answered that antibiotics are not effective against viruses (97%), they have associated side effects (97%), unnecessary use makes antibiotics ineffective (97%) and healthy people can carry antibiotic-resistant bacteria (90%). However, fewer than 80% correctly answered that using antibiotics increases a patient’s risk of antimicrobial resistant infection or that resistant bacteria can spread from person to person. Whilst the majority of HCWs (81%) agreed there is a connection between their antibiotic prescribing behaviour and the spread of antibiotic-resistant bacteria, only 64% felt that they have a key role in controlling antibiotic resistance. The top three barriers to providing advice or resources were lack of resources (19%), insufficient time (11%) and the patient being uninterested in the information (7%). Approximately 35% of UK respondents who were prescribers prescribed an antibiotic at least once in the previous week to responding to the survey due to a fear of patient deterioration or complications. Conclusion: These findings highlight that a multifaceted approach to tackling the barriers to prudent antibiotic use in the UK is required and provides evidence for guiding targeted policy, intervention development and future research. Education and training should focus on patient communication, information on spreading resistant bacteria and increased risk for individuals

Antibiotic prescribing for residents in long-term-care facilities across the UK

Background: Antimicrobial resistance (AMR) is a major public health problem. Elderly residents in long-term-care facilities (LTCFs) are frequently prescribed antibiotics, particularly for urinary tract infections. Optimizing appropriate antibiotic use in this vulnerable population requires close collaboration between NHS healthcare providers and LTCF providers. Objectives: Our aim was to identify and quantify antibiotic prescribing in elderly residents in UK LTCFs. This is part of a wider programme of work to understand opportunities for pharmacy teams in the community to support residents and carers. Methods: This was a retrospective longitudinal cohort study. Data were extracted from a national pharmacy chain database of prescriptions dispensed for elderly residents in UK LTCFs over 12 months (November 2016–October 2017). Results: Data were analysed for 341 536 residents in LTCFs across the four UK nations, from which a total of 544 796 antibiotic prescriptions were dispensed for 167 002 residents. The proportion of residents prescribed at least one antibiotic over the 12 month period varied by LTCF, by month and by country. Conclusions: Whilst national data sets on antibiotic prescribing are available for hospitals and primary care, this is the first report on antibiotic prescribing for LTCF residents across all four UK nations, and the largest reported data set in this setting. Half of LTCF residents were prescribed at least one antibiotic over the 12 months, suggesting that there is an opportunity to optimize antibiotic use in this vulnerable population to minimize the risk of AMR and treatment failure. Pharmacy teams are well placed to support prudent antibiotic prescribing and improved antimicrobial stewardship in this population

The Antibiotic Guardian Campaign:a qualitative evaluation of an online pledge-based system focused on making better use of antibiotics

Abstract Background The Antibiotic Guardian Campaign was developed to increase commitment to reducing Antimicrobial Resistance (AMR), change behaviour and increase knowledge through an online pledge system for healthcare professionals and members of the public to become Antibiotic Guardians (AG). This qualitative evaluation aimed to understand AG experiences of the campaign and perceived impact on behaviour. Methods Ninety-four AGs (48 via a survey and 46 who had agreed to future contact) were invited to participate in a telephone semi-structured interview. The sample was based on self-identification as a healthcare professional or a member of the public, pledge group (e.g. adults, primary care prescribers etc.), pledge and gender. Interviews explored how participants became aware of the campaign, reasons for joining, pledge choices, responses to joining and views about the campaign’s implementation. Interviews were analysed using the Framework Method. Results Twenty-two AGs (10 healthcare professionals and 12 members of the public) were interviewed. AGs became aware of the campaign through professional networks and social media, and were motivated to join by personal and professional concern for AMR. Choice of pledge group and pledge were attributed to relevance and potential impact on AMR and the behaviour of others through pledge enactment and promotion of the campaign. Most AGs could not recall their pledge unprompted. Most felt they fulfilled their pledge, although this reflected either behaviour change or the pledge reinforcing pre-existing behaviour. The campaign triggered AGs to reflect on AMR related behaviour and reinforced pre-existing beliefs. Several AGs promoted the campaign to others. Responding collectively as part of the campaign was thought to have a greater impact than individual action. However, limited campaign visibility was observed and the campaign was perceived to have restricted ability to reach those unaware of AMR. Conclusions AGs were motivated to reduce AMR and most felt they fulfilled their pledges although for many this appeared to be through reinforcement of existing behaviours. We recommend that the campaign engages those without pre-existing knowledge of AMR by increasing its visibility, capitalising on the diffusion of its message and including more awareness-raising content for those with limited AMR knowledge