Shared Learning: Research

Scottish Universities Life Sciences Alliance (SULSA)

Provide a brief overview of your project:

SULSA is holding a two day conference on AMR (26/27 April; The first day will showcase research that is tackling the challenges of AMR, and the second day is a policy day, and includes speakers such as the Chief Medical Officer in Scotland, representatives from funders of AMR research (the Wellcome Trust and MRC), clinicians and public health officials. One of SULSA’s main aims is to bring the Scottish life sciences research community together, and this conference will inform and coordinate fundamental and applied research activity on AMR within SULSA universities and other relevant organisations in Scotland. This conference is timely considering the UK AMR strategy is being refreshed this year.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

  1. We have a sold-out AMR conference of 150 researchers, clinicians, funders, government workers attending
  2. We have 50 poster presentations showing research across all areas of AMR and antimicrobial stewardship
  3. We are having breakout sessions to discuss topics such as: Speeding the Antibiotic Discovery Pipeline, clinical Considerations in AMR, A One Health Approach to Tackling AMR, Maximising Funding Opportunities for AMR Research, Diagnostics, and Public Health Considerations in Dealing with AMR.

How is the project to be developed in the future?:

We are funding a seed-funding grant call to promote collaboration of AMR researchers across Scotland, and to drive further innovations in AMR research.


University of Leeds (Highly Commended – Antibiotic Guardian Awards 2018)

Provide a brief overview of your project:

Research project title: Student attitudes to rapid point-of-care diagnostics and the avoidance of antibiotic resistance.

My survey research (n=206) was three pronged and looked to:

  1. Assess current knowledge of antibiotic utility and AMR in a student population
  2. Determine existing attitudes towards antibiotic prescribing amongst students
  3. To determine if point-of-care diagnostics will improve attitudes to antibiotic prescribing in a primary-care setting.

The most pertinent aim was to investigate whether the use of point-of-care diagnostics would improve attitudes to prescribing amongst ‘pester patients’ who idealise antibiotics as a ‘magic pill’ to help them get better. The outputs were to assess receptivity amongst this cohort and therefore develop recommendations for future public engagement techniques, and specific barriers to address for their successful roll-out and on-boarding.

I found that introduction of a diagnostic test would improve attitudes to prescribing and patient satisfaction: 56% of students agreed they would be happier leaving a consultation with no antibiotics (a 13% superiority achieved compared to feelings towards the existing diagnostic protocol), only 1% would remain unhappy.

My research uncovered that without understanding the wider advantage a diagnostic test confers in the fight against AMR, patients may express resistance or develop specific concerns such as the test deterring them from getting better, questioning why a doctor needs a test (do they not know what they are doing?), and ultimately deeming them unnecessary.

A set of recommendations which identified that the UK population are not homogeneous in their understanding of AMR and that specific sub-populations with very specific misconceptions exist, and tailored public engagement is therefore mandatory when rolling them out were developed.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

The survey questions asked respondents key questions about AMR and antibiotic utility in order to generate a ‘total knowledge score of antibiotics’. We fed this back to respondents and many were alarmed that they couldn’t identify simple indications e.g. ‘antibiotics cannot treat viruses or a common cold’. We received feedback that this initiated a behaviour change on interaction with their HCP.

I conducted a pilot focus group and through this, healthy discussion around what AMR is and how it is already affecting us was sparked. In addition, whilst handing out the surveys, my colleague and i engaged with students discussing the implications of AMR. I then delivered a research presentation to peers, discussing findings and promoting the importance of AMR as a public health matter. Students commented that they don’t feel AMR is prioritised compared to other public health matters such as cancer or flu jabs, my research identified ways to make AMR more relevant to the average student e.g.  consistently pairing it with sexual health such as super gonorrhoea and AMR.

Recommendations developed cite the importance and potential for point-of-care diagnostics to be introduced and suggest they could reduce the number of patients who place pressure on their GP to describe. This will be used as an evidence base for submission of a point-of-care diagnostic being developed at The University of Leeds to The Medical Research Council and should it be accepted, will ultimately lead to preservation of antibiotics.

How is the project to be developed in the future?:

Another survey iteration/ focus groups with HCPs and another group such as children. All of these will produce recommendations for submission to the Medical Research Council to support the research question of how receptive the general public are to point of care diagnostics.


University College London Hospitals (Winner – Antibiotic Guardian Awards 2018)

Provide a brief overview of your project:

Antibiotic prescribing behaviour in acute care is linked to social norms and beliefs.  The views of clinicians have been described in the literature, however despite their key role in organisational leadership, change management and finance, there is a paucity of research on the views of hospital managers on antibiotic stewardship.

This year-long Healthcare Infection Society (HIS) funded qualitative research project, led by a microbiology registrar at University College Hospital London (UCLH)  during her Ayliffe infection control fellowship, is the first multi-disciplinary British stewardship study to have included hospital managers amongst its participants.

The objective of the study was to analyse what staff at UCLH understand by the term stewardship, what their barriers and facilitators are to doing it in order to design sustainable behaviour change interventions from board to ward.

The research was designed and enhanced iteratively in collaboration with interdisciplinary team including a psychologist/qualitative researcher at the UCL Centre for Behaviour Change, UCL School of Pharmacy with public and patient involvement.

39 interviews were conducted across 5 in-patient sites across UCLH including managers, senior doctors, junior doctors, pharmacists and nurses.

Thematic analysis was applied to the data to extract key themes using an abductive approach.  Themes were mapped to behaviour change domains using the Theoretical Domains Framework.

Facilitators included stewardship metrics, strong clinical leadership, an expected new IT system with point of care e-prescribing and multi-disciplinary pharmacist led education.

Understanding of the rationale for antibiotic use was high, however staff were less familiar with the term stewardship and inter-disciplinary contributions.  Understanding was highest amongst pharmacists and areas visited frequently by infection staff.  Managers reported spending little time discussing stewardship as, perceiving it as an ‘operational’ not ‘strategic’ issue and not enough of a burning platform.

Barriers included antibiotic knowledge, fear of under treating sepsis, diagnostics and inaccessibility of electronic prescribing systems.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

1) Staff engagement – taking the time to recruit and conduct one to one face to face depth interviews with a range of doctors, nurses, pharmacist and managers at each site and at all levels including executive board members has provided detailed insight into how staff genuinely perceive the threat of antibiotic resistance and the need for stewardship and where it sits in amongst other priorities.  Researchers would travel to participants place of work to conduct interviews and this willingness to go to busy clinical staff has resulted in a high degree of staff engagement on stewardship.  Involvement of the executive board may be particularly helpful ensuring support for future work.

2) Local behavioural analysis – by undertaking a local analysis using behavioural science it will be possible to map evidence based stewardship interventions to our trust in order to enhance their success.

3) Dissemination of data for action – Data has been presented to the research team, to our local stewardship strategy group and as an oral presentation at the national BSAC Spring Conference and will be presented at infection departmental clinical governance meetings in order to inform local and national stewardship strategies.  The recent establishment of the multi-disciplinary UCLH antimicrobial stewardship strategy group and the appointment of 2 new consultants with dedicated stewardship PA time provide an opportunity for this data to become embedded in our clinical workflow.

How is the project to be developed in the future?:

Our data suggests that sepsis criteria, 1 hour CQUIN sepsis targets and fear of missing sepsis are key barriers to antimicrobial stewardship at UCLH, particularly in acute care settings.  National data also suggests a need for more research and intervention design in acute care settings.

According to the ESPAUR report, only 9.2% of 72 hour ‘review and revise’ decisions were to stop antibiotics, most were to continue.  This has prompted the design of multimodal behaviour change interventions such as the ARK study, a 5 year NIHR funded research study which aims to improve ‘review and revise’ decision making at 72 hours.

Consequently, research has already begun on phase 2 of the project which will involve interviewing doctors, nurses and pharmacists in ED and AMU on their views on interventions that will help them improve their stewardship.  This will enable the local design of evidence based stewardship interventions to pilot based on behaviour change science.

This is believed to be one of few qualitative research studies on stewardship in a British ED setting and has potential to inform behaviour change strategies targeting the 12-24 hour antibiotic review point, an area of increased national attention.


University of the Punjab

Provide a brief overview of your project:

In the unending battle of microbes against antimicrobials, the microbes appear to be winning, and the pipeline of drugs is near to the end. Antimicrobial resistance (AMR) is a rising threat for community health which has appealed the attention of international and national organizations like WHO, SHEA, IDSA etc. For only the fourth time in history, on 21st September 2016, AMR topic took central juncture at a United Nations General Assembly (UNGA) high level convention to progress towards the 2030 SDGs. I am working on a mixed methodological study desig in which quantitative together with qualitative

studies are wielded to evaluate the factors of AMR in Pakistan. For qualitative study, semi-structured interviews are conducted of the physicians, pharmacist and patients to highlight determinants of AMR. In the quantitative studies, first a survey was conducted to evaluate the number of antimicrobial stewardship practices. Another quantitative point prevalence survey of antimicrobial use (AMU) and health care associated infections was conducted among the representative sample of all in-patient wards of private, public and charity hospitals by using the standard methodology employed by ECDC and ESAC.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

In Pakistan, there are no local guidelines for antibiotic use. These studies are sort of situational analysis to give a baseline. By doing PPS, we came to know that prophylactic use of ceftrioxone, metronidazole and ciprofloxacin is very high. Second, knowledge of pharmacists and physicians is very poor about ASP. Lastly, there are very few antimicrobial stewardship activities taking place in hospitals.

How is the project to be developed in the future?:

Findings from this situation analysis (PPS) will provide an opportunity to identify interventions to be implemented through antimicrobial stewardship programs in hospital. This will yield important information to convince the policy-makers and budget holders to invest in AMR prevention and containment measures and serves as a baseline against which improvements may be monitored.Based on the situation analysis, the key gaps in infrastructure and HR skills will also be identified. I’ll work to establish technical working groups and sub-groups in order to push this forward. Political support from the government leadership is critical and is critical to ensure allocation of the budget, so I’ll not forget to involve the financial advisors in the process. Partnerships with behaviour change leaders and thought-influencers are important through the involvement of faith based organizationa (FBO)  as well as civil society organizations (CSO). The stake holder meetings with different partners will be conducted to brainstorm.