Championing responsible antibiotic use

Ella Rhodes reports on a role for psychology and psychologists in tackling a major societal issue.

The potential role for psychologists in combating the rise in antibiotic misuse has been highlighted by Dr Helen Lambert, the new Antimicrobial Resistance (AMR) Champion for the Economic and Social Research Council. Lambert said the rise in resistance to the drugs is as much a societal problem as a technological one.

Lambert, the first to hold the champion position which was set up as part of a £150,000 grant, said social science research was as important as laboratory research in tackling the problem which is affecting people worldwide. She added: ‘Social organisation is just as important as what happens in the laboratory. We need to find answers to questions such as why antibiotics are often overused, how pharmaceutical supply chains and the organisation of healthcare affect access to antibiotics, or what part farming practices might play in AMR transmission.’ Lambert, a Reader in Medical Anthropology from the University of Bristol’s School of Social and Community Medicine, said she would aim to engage with social scientists to undertake research in the field as well as highlighting the need for social science evidence to lead to new ways of dealing with the threat of infections caused by antibiotic-resistant bacteria.

Professor Karen Rodham (Staffordshire University), Chair of the British Psychological Society’s Division of Health Psychology, pointed out why AMR poses such a problem and how health psychologists in particular could be part of the solution. She outlined evidence that has shown health professionals do not always recognise it as a problem. She said: ‘In a 2013 study by Wood, Phillips, Brookes-Howell and colleagues, 80 primary care clinicians in nine European countries were interviewed and most stated that antibiotic resistance was not a problem in their practice. Another contributory factor concerns patient behaviour, both those who fail to take the whole prescribed course of antibiotics and those who can be very forceful in their demand for antibiotics from their GP.’

But what exactly should be done to take on this issue? Rodham said knowledge translation was one of the key lines of attack – not only for the health professionals who know that they should not be over-prescribing antibiotics, but also for the patients who demand antibiotics inappropriately. She outlined three ways in which health psychologists could lead the way. First, by providing communication skills training to increase health professionals’ confidence in their ability to have the challenging conversation with patients to explain why the prescription of antibiotics is not appropriate; second to train health professionals to engage in shared decision-making with their patients; and third, by designing theory-informed awareness-raising materials to address misconceptions about the efficacy of antibiotics. She concluded: ‘In short, health psychologists are very well placed to contribute to solving this thorny issue, and I encourage the members of the Division of Health Psychology to heed the call to arms from the AMR Champion to join the multi-disciplinary social scientist army.’

Sarah Golding (University of Surrey) has recently begun a PhD looking into antibiotic use in vets and farmers. She said we should not underestimate the use of antibiotics in the farming industry. She told The Psychologist: ‘Over half of all bacteria that infect humans are transmitted between animals and humans, so it is vital that the problem of increasing AMR is also tackled within veterinary medicine. The One Health initiative is based upon the idea that human, animal, and ecosystem health are inextricably linked and it encourages doctors, veterinarians and public health experts to work together.’

Psychologists who work alongside these professionals, Golding added, can help to tackle AMR by researching methods of knowledge exchange, and evaluating the effectiveness of public health messages. She said: ‘The potential consequences to society from a lack of effective antibiotics are enormous. Multi-drug resistant bacteria are already causing infections in people and animals that simply cannot be treated; rates of these infections are predicted to increase, with potentially devastating effects on our economies, our health and healthcare systems, and our food security. Health psychologists can assist by encouraging different groups of people, including patients, parents, pet-owners, farmers, doctors, pharmacists, and veterinarians, to use antibiotics responsibly.’

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