A Multicultural Approach to Decreasing Unnecessary Antibiotic Prescribing for Pharyngitis

2.50
Hdl Handle:
http://hdl.handle.net/10755/621750
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
A Multicultural Approach to Decreasing Unnecessary Antibiotic Prescribing for Pharyngitis
Other Titles:
Global Perspectives on Multi-Drug-Resistant Infections
Author(s):
Camacho-Walsh, Mercedes; Ellis, Corinne Schultz
Lead Author STTI Affiliation:
Mu Theta-at-Large
Author Details:
Mercedes Camacho-Walsh, RN, FNP-BC, Professional Experience: Ms. Camacho-Walsh has twenty five years of clinical experience, including active duty United States Army nurse, Emergency Department Nurse, and Family Nurse Practitioner. She has provided acute care and primary care for patient of all ages in both hospital and outpatient settings in various regions of the United States and in South and Central America. These included ample exposure to patient conditions including infectious diseases. Her experience with multicultural patients is also drawn from practicing in We Care Pediatrics and her privately owned nurse practice clinic (Occupational and Community Health Services) located in an urban multicultural region of New Jersey. Her faculty appointments included Rutgers, The State University of New Jersey and Columbia University. Her hospital appointments included Newark Beth Israel Medical Center (NJ), Mount Sinai Medical Center and Columbia Presbyterian (NY), Jersey City Medical Center (NJ), Loma Linda Medical Center (California), and US Army Medical Element (NY). Author Summary: Author has previously published in peer review journals including "AGREE Appraisal of The 2012 Guideline for the Diagnosis and Management of Pharyngitis," Poster presentation "Decreasing antibiotic prescribing for pharyngitis," at the Emergency Nurses Association 2013 Conference, and "Decreasing antibiotic prescribing in minority populations" at Saint Peter's University 2015.NLN Video Award for "A Bridge Between Two Cultures" depicting a post disaster medical mission to Peru.
Abstract:

Antimicrobial resistance is a global crisis. In the United States alone, two million people are infected every year with untreatable microbes, resulting in 23,000 deaths (CDC, 2014). Over- prescribing of antibiotics has been cited as major contributor to the crisis. (WHO, 2015). According to the CDC Morbidity and Mortality Weekly Report (2011), 50% of antibiotic prescriptions in the United States are unnecessary. Non-prescription antibiotics account for 19-100% of antibiotic use outside northern Europe and North America, with increased antimicrobial resistance in countries with greater use (Morgan, Okeke, Laxminarayan, Perencevich & Weisenberg, 2011).

 International guidelines for pharyngitis approach diagnostic scoring and the use of rapid antigen testing differently, but they largely concur on the need to decrease unnecessary antibiotic prescribing (Shullman, 2014; Ebell, 2014; Cohen, et al, 2015; and Hoare & Ward & Arroll, 2016). Differences in the perceived benefit of rapid antigen tests to aid in the detection and treatment of streptococcal pharyngitis have also been addressed (Lean, Arnup, Danchin & Steer, 2014; Steward, et al, 2014; and Cohen, et al, 2016). A 2103 Cochrane review (Spinks) examined the actual rate of rheumatic fever in various populations, identified complications due to untreated Streptococcal pharyngitis, and the described the natural course of the disease.

Using the 2012 Infectious Disease Society of America Guidelines, Ellis & Camacho (2015) devised a management algorithm for prescribing antibiotics based on clinical presentation, rapid antigen test results, and likelihood of complications according to age and comorbidities. The algorithm provides clinicians with a succinct evidence-based pathway for clinical management of pharyngitis and opens dialogue with multicultural patients concerning their ideas, concerns and expectations.

Despite the vast amount of clinical evidence, many clinicians continue to overprescribe antibiotics. Barriers to clinician antibiotic stewardship are lack of knowledge of clinical practice guidelines and their application, and lack of understanding of patient expectations in different cultural settings. Perceived pressure to prescribe antibiotics, and failure to ascertain the actual expectations of patients can lead to unnecessary antibiotic prescribing (Mathys, 2009, and Mustafa, Wood & Elwyn, 2014). Cultural differences may account for increased use and expectations of antibiotic prescribing, but it is significantly less than that perceived by clinicians (Watkins, Lousisek, Sanchez, Albert, Roberts & Kicks, 2015).

Combating the spread of global antimicrobial resistance requires cooperation of clinicians around the world. The purpose of this presentation is to reduce unnecessary antibiotic prescribing across different cultures. This presentation demonstrates application of key clinical guideline recommendations, and addresses patient cultural considerations andexpectations. A seven-minute trilingual video (English, Spanish and Arabic with English subtitles) uses a multicultural setting to depict sample clinical scenarios. The video demonstrates brief and friendly discussions with patients on the risk of infection and potential complications, versus the risk of developing resistance to antibiotics. Alternative treatment modalities for pharyngitis are also presented.

Keywords:
Antimicrobial Resistance; Multicultural; Pharyngitis
Repository Posting Date:
10-Jul-2017
Date of Publication:
10-Jul-2017
Other Identifiers:
INRC17L10
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleA Multicultural Approach to Decreasing Unnecessary Antibiotic Prescribing for Pharyngitisen_US
dc.title.alternativeGlobal Perspectives on Multi-Drug-Resistant Infectionsen
dc.contributor.authorCamacho-Walsh, Mercedesen
dc.contributor.authorEllis, Corinne Schultzen
dc.contributor.departmentMu Theta-at-Largeen
dc.author.detailsMercedes Camacho-Walsh, RN, FNP-BC, Professional Experience: Ms. Camacho-Walsh has twenty five years of clinical experience, including active duty United States Army nurse, Emergency Department Nurse, and Family Nurse Practitioner. She has provided acute care and primary care for patient of all ages in both hospital and outpatient settings in various regions of the United States and in South and Central America. These included ample exposure to patient conditions including infectious diseases. Her experience with multicultural patients is also drawn from practicing in We Care Pediatrics and her privately owned nurse practice clinic (Occupational and Community Health Services) located in an urban multicultural region of New Jersey. Her faculty appointments included Rutgers, The State University of New Jersey and Columbia University. Her hospital appointments included Newark Beth Israel Medical Center (NJ), Mount Sinai Medical Center and Columbia Presbyterian (NY), Jersey City Medical Center (NJ), Loma Linda Medical Center (California), and US Army Medical Element (NY). Author Summary: Author has previously published in peer review journals including "AGREE Appraisal of The 2012 Guideline for the Diagnosis and Management of Pharyngitis," Poster presentation "Decreasing antibiotic prescribing for pharyngitis," at the Emergency Nurses Association 2013 Conference, and "Decreasing antibiotic prescribing in minority populations" at Saint Peter's University 2015.NLN Video Award for "A Bridge Between Two Cultures" depicting a post disaster medical mission to Peru.en
dc.identifier.urihttp://hdl.handle.net/10755/621750-
dc.description.abstract<p><span>Antimicrobial resistance is a global crisis. In the United States alone, two million people are infected every year with untreatable microbes, resulting in 23,000 deaths (CDC, 2014). Over- prescribing of antibiotics has been cited as major contributor to the crisis. (WHO, 2015). According to the CDC Morbidity and Mortality Weekly Report (2011), 50% of antibiotic prescriptions in the United States are unnecessary. Non-prescription antibiotics account for 19-100% of antibiotic use outside northern Europe and North America, with increased antimicrobial resistance in countries with greater use (Morgan, Okeke, Laxminarayan, Perencevich & Weisenberg, 2011).</span></p> <p> International guidelines for pharyngitis approach diagnostic scoring and the use of rapid antigen testing differently, but they largely concur on the need to decrease unnecessary antibiotic prescribing (Shullman, 2014; Ebell, 2014; Cohen, et al, 2015; and Hoare & Ward & Arroll, 2016). Differences in the perceived benefit of rapid antigen tests to aid in the detection and treatment of streptococcal pharyngitis have also been addressed (Lean, Arnup, Danchin & Steer, 2014; Steward, et al, 2014; and Cohen, et al, 2016). A 2103 Cochrane review (Spinks) examined the actual rate of rheumatic fever in various populations, identified complications due to untreated Streptococcal pharyngitis, and the described the natural course of the disease.</p> <p>Using the 2012 Infectious Disease Society of America Guidelines, Ellis & Camacho (2015) devised a management algorithm for prescribing antibiotics based on clinical presentation, rapid antigen test results, and likelihood of complications according to age and comorbidities. The algorithm provides clinicians with a succinct evidence-based pathway for clinical management of pharyngitis and opens dialogue with multicultural patients concerning their ideas, concerns and expectations.</p> <p>Despite the vast amount of clinical evidence, many clinicians continue to overprescribe antibiotics. Barriers to clinician antibiotic stewardship are lack of knowledge of clinical practice guidelines and their application, and lack of understanding of patient expectations in different cultural settings. Perceived pressure to prescribe antibiotics, and failure to ascertain the actual expectations of patients can lead to unnecessary antibiotic prescribing (Mathys, 2009, and Mustafa, Wood & Elwyn, 2014). Cultural differences may account for increased use and expectations of antibiotic prescribing, but it is significantly less than that perceived by clinicians (Watkins, Lousisek, Sanchez, Albert, Roberts & Kicks, 2015).</p> <p>Combating the spread of global antimicrobial resistance requires cooperation of clinicians around the world. The purpose of this presentation is to reduce unnecessary antibiotic prescribing across different cultures. This presentation demonstrates application of key clinical guideline recommendations, and addresses patient cultural considerations andexpectations. A seven-minute trilingual video (English, Spanish and Arabic with English subtitles) uses a multicultural setting to depict sample clinical scenarios. The video demonstrates brief and friendly discussions with patients on the risk of infection and potential complications, versus the risk of developing resistance to antibiotics. Alternative treatment modalities for pharyngitis are also presented.</p>en
dc.subjectAntimicrobial Resistanceen
dc.subjectMulticulturalen
dc.subjectPharyngitisen
dc.date.available2017-07-10T17:12:54Z-
dc.date.issued2017-07-10-
dc.date.accessioned2017-07-10T17:12:54Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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