Human Resources for Health: Reducing inappropriate use of antibiotics in LMICs

12 February, 2020

Citation, abstract and comment from me below.

This new paper in Human Resources for Health 'identified five areas in which strengthening HCP education could enhance professionalism and reduce the inappropriate use of antibiotics: updating curricula to better cover the need for appropriate use of antibiotics; imparting stronger communication skills to manage patient demand for medications; inculcating essential professional ethics; building skills required for effective collaboration between doctors, pharmacists, and lay HCPs; and ensuring access to (unbiased) continuing medical education.'

CITATION: Khan, M.S., Bory, S., Rego, S. et al. Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries?. Hum Resour Health 18, 10 (2020). https://doi.org/10.1186/s12960-020-0452-7

ABSTRACT

Background: Healthcare providers’ (HCPs) professionalism refers to their commitment and ability to respond to the health needs of the communities they serve and to act in the best interest of patients. Despite attention to increasing the number of HCPs in low- and middle-income countries (LMIC), the quality of professional education delivered to HCPs and their resulting professionalism has been neglected. The Global Action Plan on Antimicrobial Resistance (AMR) seeks to reduce inappropriate use of antibiotics by urging patients to access antibiotics only through qualified HCPs, on the premise that qualified HCPs will act as more responsible and competent gatekeepers of access to antibiotics than unqualified HCPs.

Methods: We investigate whether weaknesses in HCP professionalism result in boundaries between qualified HCPs and unqualified providers being blurred, and how these weaknesses impact inappropriate provision of antibiotics by HCPs in two LMIC with increasing AMR — Pakistan and Cambodia. We conducted 85 in-depth interviews with HCPs, policymakers, and pharmaceutical industry representatives. Our thematic analysis was based on a conceptual framework of four components of professionalism and focused on identifying recurring findings in both countries.

Results: Despite many cultural and sociodemographic differences between Cambodia and Pakistan, there was a consistent finding that the behaviour of many qualified HCPs did not reflect their professional education. Our analysis identified five areas in which strengthening HCP education could enhance professionalism and reduce the inappropriate use of antibiotics: updating curricula to better cover the need for appropriate use of antibiotics; imparting stronger communication skills to manage patient demand for medications; inculcating essential professional ethics; building skills required for effective collaboration between doctors, pharmacists, and lay HCPs; and ensuring access to (unbiased) continuing medical education.

Conclusions: In light of the weaknesses in HCP professionalism identified, we conclude that global guidelines urging patients to only seek care at qualified HCPs should consider whether HCP professional education is equipping them to act in the best interest of the patient and society. Our findings suggest that improvements to HCP professional education are needed urgently and that these should focus not only on the curriculum content and learning methods, but also on the social purpose of graduates.

SELECTED EXTRACT

Another common benefit given to HCPs by pharmaceutical companies, particularly doctors, was access to scientific information about new medicines or a medical condition, either by visiting the doctor’s clinic or by inviting the doctor to an expensive hotel or overseas destination.

COMMENT (Neil PW): I would add that it is critical that prescribers have access to reliable, unbiased guidance on how to select and prescribe antibiotics. It is *not* acceptable that prescribers rely on information from pharmaceutical companies. It is well known that such information is commonly biased and is designed, at least in part, to persuade doctors to use particular drugs that may well be inappropriate for the situation at hand. ‘Globally, most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ World Medicines Report, WHO. http://www.hifa.org/projects/prescribers-and-users-medicines

Best wishes, Neil

Joint Coordinator, HIFA Project on Information for Prescribers and Users of Medicines http://www.hifa.org/projects/prescribers-and-users-medicines [sponsorship opportunity]

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org