Project: Perceptions of antimicrobial resistance and prescriber knowledge translation preferences

1. ENGAGING MEDICAL AND VETERINARY
STUDENTS IN AMR COMMUNICATIONS RESEARCH
Courtney Primeau, MPH PhD
NCCPH KT Seminar
September 2020

2. OVERVIEW OF PRESENTATION
1. Background on antimicrobial resistance (AMR)
2. Overall research objectives
3. Research methods
4. Thematic analysis results
5. Key findings
6. Challenges/limitations
7. Conclusions

3. WHAT IS ANTIMICROBIAL
RESISTANCE (AMR)?
o Occurs when micro-organisms (i.e.
bacteria, viruses, fungi, parasites)
survive exposure to a drug that
would normally kill them or stop
their growth
o AMR has increasingly become a
growing global health concern, with
resistant infections occurring in
hospitals, health care settings, and
the wider community
o AMR threatens our ability to treat
and prevent illness in human and
veterinary medicine
O’Neill et al., 2016

4. DRIVERS OF AMR
Human antimicrobial use Veterinary antimicrobial use
Infection control in human and
veterinary hospitals/clinics
International travel
Lack of development of new
antimicrobials
Farm biosecurity practices

5. PROJECT BACKGROUND
o Due to the complex nature of AMR and its ability to impact several societal
sectors, a multi-sectoral One Health approach is necessary to address the
issue
o A significant driver of AMR is AMU in human and veterinary medicine
­ Education and awareness among antimicrobial prescribers and dispensers critical
­ Both physicians and veterinarians are important stakeholders to engage in discussion about
action and approaches to reduce AMR
o Knowledge translation and communication initiatives related to AMR have
primarily focused on improving the use of antimicrobials among the general
public and physicians
5

6. RESEARCH OBJECTIVES
6
Explore medical and
veterinary student
perceptions of AMR and its
drivers
Identify key messages,
knowledge translation
methods, and dissemination
strategies for
communication/KT of AMR
information

7. CHAPTER 5 METHODS
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Students enrolled in
the Doctor of
Veterinary Medicine
(DVM), or Doctor of
Medicine (MD)
programs in Ontario,
Canada
Study
Population
4 focus groups were
conducted using a
semi-structured guide
Focus Groups
Thematic analysis was
used to identify the
key concepts and
themes
Thematic
Analysis

8. ETHICS
APPROVAL
o The study protocol was approved by the University
of Guelph Research Ethics Board and the Public
Health Agency of Canada Research Ethics Board
o The relevant ethics committees at each participating
university also reviewed and approved the study
protocol

9. FOCUS GROUP
GUIDE
1. Perceptions of AMR
2. Content of Communication/KT Products
3. Format of Communication/KT Products
4. Delivery/Transmission of Communication/KT Products
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10. 1. PERCEPTIONS OF AMR
1. Tell me what you know about AMR.
2. What is the role of a physician/veterinarian
in the issue of AMR?

11. 2. CONTENT OF
COMMUNICATION/KT MATERIALS
ABOUT AMR
1. What do
physicians/veterinarians
need to know about
AMR, outside of the
clinical realm?
2. What do your
patients/clients need to
know about AMR?

12. 3. FORMAT OF
KT/COMMUNICATION
MATERIALS
For this section, participants were
presented with a variety of publicly-
available communication materials (e.g.
infographics, short reports, fact sheets,
long reports), and asked to focus on the
format of the communication piece,
rather than their content.

13. EXAMPLE KT
/COMMUNICATION
MATERIALS

14. EXAMPLE KT/COMMUNICATION
MATERIALS

15. 3. FORMAT OF COMMUNICATION MATERIALS
1. For each example communication material presented,
• What do you think about this type of communication material?
• What are the strengths of using this type of communication material to communicate AMR
information?
• What are the weaknesses of using this type of communication material to communicate AMR
information?
2. You were presented with different options for AMR communication materials. What is the
most effective method of communicating the complexities of AMR to you in the future, as
someone diagnosing and prescribing antimicrobials?
• Which format did you prefer? Which was the most useful?
• How could you use these in the future?
• What would be the most effective method of communicating with your patients/clients?

16. 4. TRANSMISSION OF
COMMUNICATION MATERIALS
1. Once you are practicing
physicians/veterinarians, how would you like
to receive information about AMR?

17. THEMATIC
ANALYSIS
RESULTS

18. KNOWLEDGE & PERCEPTIONS OF AMR
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Reliance on
antimicrobials in human
and veterinary medicine
Drivers of AMR across
human and veterinary
medicine
Collaboration between
human and veterinary
health professionals
External influences on
perceptions of AMR

19. CONTENT OF KT/COMMUNICATION MATERIALS
ABOUT AMR
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Content to address
pressure to prescribe
antimicrobials
Content targeted
appropriately for
different audiences
Content to improve
understanding among
physicians and
veterinarians

20. CONTENT TO ADDRESS PRESSURE TO PRESCRIBE
ANTIMICROBIALS
o Patient pressure to prescribe was described in depth during the focus group with
medical students, as were the challenges balancing patient needs and desires with
prudent use of antimicrobials.
o Both medical and veterinary students felt that their patients and clients needed to
know about the issue of AMR, what it is, and how it could impact them, as well as
the difference between bacterial and viral infections
o The participants felt that if these aspects were communicated effectively to patients
and clients, it could decrease the pressure to prescribe, and potentially have an
impact on AMR.

21. “Sometimes it is confusing for patients. Sometimes your infection is
caused by bacteria, sometimes it’s caused by a virus. It can send
confusing messaging…They need a basic understanding of viruses
and bacteria and how we would go about treating each.”

22. “They need to have a general understanding of AMR—
what causes it, why it is important, so that they don't
pressure the physician and they do understand the issue.

23. CONTENT TARGETED FOR
DIFFERENT AUDIENCES
o Across all focus groups, students indicated
the need to consider different target
audiences when developing communication
products to enhance knowledge and
understanding of AMR
o Important to tailor products to the target
audience to enhance awareness and
information uptake
o One communication product would not be
suitable for all target audiences
• Comprehensive KT strategy needed

24. “You need to be aware of differences in knowledge, and what
the average person in society is aware of. You need a
general, widespread approach to educate and you can’t just
use one tool to reach everyone”

25. “There is no one-size-fits-all approach when it comes to
communicating this type of information, especially because
it is so complex.”

26. FORMAT OF KT/COMMUNICATION MATERIALS
ABOUT AMR
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Balancing the quantity
of information with
visual appeal

27. BALANCING THE QUANTITY OF
INFORMATION WITH VISUAL
APPEAL
o Overall, students felt that the most
useful communication product for
practicing physicians or
veterinarians was the fact sheet
o Both medical and veterinary
students felt that the example
infographics were the least useful
communication products, as they
didn’t allow much explanation
about “…why AMR is important,
why we should care, and what we
should do about it”
Adults aged 60 years and older are prescribed antibiotics 1.5 times more than
any other age group in Canada.
Asymptomatic bacteriuria and upper
respiratory infections, including sinusitis,
are the most likely conditions where antibiotics
are prescribed unnecessarily.
› Up to 80% of patients with asymptomatic
bacteriuria receive antibiotics. This can lead to
adverse events such as C. difficile infections.
› Antibiotics are rarely indicated for upper respiratory
illnesses, which are often viral or, if bacterial, are
typically self-limited.
KEY CLINICAL POINTS
Asymptomatic bacteriuria:
› The presence of bacteria in the bladder/urine
without symptoms pertaining to the urinary tract
is referred to as asymptomatic bacteriuria. This
represents a colonization state rather than a
bacterial infection.
› Pyuria (white blood cells in urine) is very common
in asymptomatic bacteriuria and is not an
indication for antibiotic therapy.
› Screening urine for bacteriuria or pyuria in an
asymptomatic patient or a patient with non-
specific symptoms is not recommended.
PRESCRIBE
ANTIBIOTICS WISELY
The overuse and misuse of antibiotics is contributing to the
development of antibiotic resistance.

28. “A good amount of information so that you are actually
learning something, but not too much to overload you to the
point where you can’t even determine what the key
messages are.”

29. DISSEMINATION OF KT/COMMUNICATION
MATERIALS ABOUT AMR
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Accessibility and reach
of communication
materials

30. ACCESSIBILITY AND REACH OF
KT/COMMUNICATION MATERIALS
o The importance of making communication products accessible to the target
audiences was discussed by both student groups
o Veterinary students felt that distributing communication products to clinics on
a regular basis would be effective, particularly for those in small animal
practice
o Makes the products accessible to both vets and clients
o Medical students made similar comments
o The importance of social media was also a key discussion point

31. “…it [social media] is a really good way to reach the general public.
So many people use social media, and this could be a good way to
raise more attention and awareness of the issue.”

32. KEY FINDINGS
o The results of the focus groups show that veterinary and medical students believe
that AMR is an important global issue
o Highlighted AMU in food-producing animals and human medicine as key drivers
o Both veterinary and medical student discussions highlighted the importance of
addressing patient/client pressure to prescribe antimicrobials
o Both veterinary and medical students indicated that a short, two-page fact sheet
was their preferred communication product
o This research will help inform the development of future communication materials
and support development of AMR-KTT tools tailored to the needs of different
professional groups
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33. RESEARCH
CHALLENGES &
LIMITATIONS
o Participant recruitment was challenging, particularly
with medical students
• Fewer focus groups were conducted than originally
planned
o We attempted to include pharmacy students in the
study, but faced similar challenges with recruitment
o It is important to acknowledge that the participants
in the focus groups were students, and not
professionals that are currently working in the field

34. CONCLUSIONS
o By investigating student
perspectives, researchers will
be able to develop effective,
targeted communication tools
to address AMR in each of
these groups of health
professionals
o Future research should
incorporate other health
professionals
o Incorporating diverse
viewpoints from antimicrobial
prescribers is necessary to
determine key messages,
format, and method of
transmission of
communication/KT products

35. ACKNOWLEDGEMENTS
PhD Advisory Committee
• Advisors: Dr. Jane Parmley (advisor), Dr. Scott
McEwen (co-advisor)
• Committee Members: Dr. Carolee Carson, Dr.
Jennifer McWhirter
Funding Sources
• OVC Doctoral Fellowship
• Genomics Research and Development Initiative
National Collaborating Centres for Public Health

36. QUESTIONS?
cprimeau@uoguelph.ca