Medicine and Health Sciences Commons^™

Delayed Antibiotic Prescribing Strategies—Time To Implement?, Amanda Mccullough, P. Glasziou

Amanda McCullough

EXTRACT Despite growing concern over antibiotic resistance, global antibiotic use continues to rise.1 Outpatients in the United States used more than 30 million antibiotics for acute respiratory infections in 2010,2 yet those prescriptions offered minimal or no benefits for most patients. Since antibiotic use drives the development of antibiotic resistance, simple and effective interventions to curb antibiotic use and slow the development of resistance are urgently needed. A delayed prescription strategy is an intervention that may offer an acceptable compromise between immediate and no antibiotic prescription.

Interventions For Enhancing Adherence To Treatment In Adults With Bronchiectasis (Review), Amanda Mccullough, Elizabeth T. Thomas, Cristin Ryan, Judy Bradley, Brenda O'Neill, Stuart Elborn, Carmel Hughes

Amanda McCullough

Background

Bronchiectasis is characterised by a widening of the airways, leading to excess mucus production and recurrent infection. It is more prevalent in women and those in middle age. Many patients with bronchiectasis do not adhere to treatments (medications, exercise and airway clearance) prescribed for their condition. The best methods to change these adherence behaviours have not been identified.

Objectives

To assess the effects of interventions to enhance adherence to any aspect of treatment in adults with bronchiectasis in terms of adherence and health outcomes, such as pulmonary exacerbations, health-related quality of life and healthcare costs.

Search methods

We searched …

A Systematic Review Of The Public’S Knowledge And Beliefs About Antibiotic Resistance, Amanda Mccullough, Sanjoti Parekh, John Rathbone, Christopher Del Mar, Tammy Hoffmann

Amanda McCullough

OBJECTIVES The objective of this study was to systematically review quantitative and qualitative studies on the public's knowledge and beliefs about antibiotic resistance. METHODS We searched four databases to July 2014, with no language or study design restrictions. Two reviewers independently extracted data. We calculated the median (IQR) of the proportion of participants who agreed with each statement and synthesized qualitative data by identifying emergent themes. RESULTS Of 3537 articles screened, 54 studies (41 quantitative, 3 mixed methods and 10 qualitative) were included (55 225 participants). Most studied adults (50; 93% studies) and were conducted in Europe (23; 43%), Asia …

Predictors Of Adherence To Treatment In Bronchiectasis, Amanda Mccullough, Michael Tunney, J Elborn, Judy Bradley, Carmel Hughes

Amanda McCullough

Objectives: We aimed to determine if beliefs about treatment, clinical factors and quality of life predicted adherence to treatment in patients with bronchiectasis. Methods: We recruited participants with confirmed bronchiectasis to a one-year study. We calculated adherence to treatment using medication possession ratios and self-report. Baseline Beliefs about Medicines, clinical, demographic and Quality of Life Questionnaire- Bronchiectasis data were collected. We used logistic regression to determine predictors of adherence to treatment during the subsequent year. Results: Seventy-five participants were recruited. Beliefs about harm, age and total number of prescribed medications were predictors of adherence to inhaled antibiotics. Concerns about medication, …

Defining The Content And Delivery Of An Intervention To Change Adherence To Treatment In Bonchiectasis (Can-Be): A Qualitative Approach Incorporating The Theoretical Domains Framework, Behavioural Change Techniques And Stakeholder Expert Panels, Amanda Mccullough, Cristin Ryan, Brenda O'Neill, Judy Bradley, J Stuart Elborn, Carmel Hughes

Amanda McCullough

Background: Low patient adherence to treatment is associated with poorer health outcomes in bronchiectasis. We sought to use the Theoretical Domains Framework (TDF) (a framework derived from 33 psychological theories) and behavioural change techniques (BCTs) to define the content of an intervention to change patients’ adherence in bronchiectasis (Stage 1 and 2) and stakeholder expert panels to define its delivery (Stage 3).

Not In My Backyard: A Systematic Review Of Clinicians’ Knowledge And Beliefs About Antibiotic Resistance, Amanda Mccullough, John Rathbone, Sarah Parekh, Tammy Hoffmann, Chris Del Mar

Amanda McCullough

Exercise and physical activity are important components in both the management and treatment of type 2 diabetes. Exercise promotes multiple beneficial effects for diabetics; however, some studies have shown that when some individuals undergo an exercise program, this can cause behavioural compensatory responses. Therefore, we investigated whether an aerobic exercise program influences sedentary behavior (SB) and moderate-vigorous physical activity (MVPA) in type 2 diabetics. Eight volunteers (51.1±8.2 years; 4 men) underwent an exercise program (3 d.wk-1, 50– 60% of VO2 peak, 30–60 min) for 8 weeks. SB and MVPA were measured by triaxial accelerometers pre- and post-exercise intervention. Cardiorespiratory fitness, …

Antibiotic Resistance: What Can Be Done In Primary Care To Alleviate The Crisis?, Malene Hansen, Amanda Mccullough, Tammy Hoffman, Mieke Van Driel, Chris Del Mar

Amanda McCullough

Numerous opportunities are available in primary care for alleviating the crisis of increasing antibiotic resistance. Preventing patients from developing an acute respiratory infection (ARI) will obviate any need for antibiotic use downstream. Hygiene measures such as physical barriers and hand hygiene, and possibly vaccination and exercise, may be effective. Also, a large range of complementary and alternative medicines (e.g. zinc, vitamin C and probiotics) are proposed for preventing and treating ARIs, but evidence for efficacy is scarce. General practitioners’ (GPs) attitudes towards antibiotic prescribing are a major factor in the prescribing for ARIs. Professional interventions with educational components are effective, …

Written Information For Patients On The Use Of Antibiotics In Acute Upper Respiratory Infections In Primary Care, Jack O'Sullivan, Robert Harvey, Amanda Mccullough, Paul Glasziou

Amanda McCullough

To determine the effect of patient information on antibiotic use in patients presenting to primary care settings with URTIs

Treatment Adherence And Health Outcomes In Patients With Bronchiectasis, Amanda Mccullough, Michael Tunney, Alexander Quittner, Stuart Elborn, Judy Bradley, Carmel Hughes

Amanda McCullough

Background: We aimed to determine adherence to inhaled antibiotics, other respiratory medicines and airway clearance and to determine the association between adherence to these treatments and health outcomes (pulmonary exacerbations, lung function and Quality of Life Questionnaire-Bronchiectasis [QOL-B]) in bronchiectasis after 12 months.Methods: Patients with bronchiectasis prescribed inhaled antibiotics for Pseudomonas aeruginosa infection were recruited into a one-year study. Participants were categorised as " adherent" to medication (medication possession ratio ≥80% using prescription data) or airway clearance (score ≥80% in the Modified Self-Reported Medication-Taking Scale). Pulmonary exacerbations were defined as treatment with a new course of oral or intravenous antibiotics …

'All Illness Is Personal To That Individual': A Qualitative Study Of Patients' Perspectives On Treatment Adherence In Bronchiectasis, Amanda Mccullough, Michael Tunney, Stuart Elborn, Judy Bradley, Carmel Hughes

Amanda McCullough

Background: Adherence to treatment is low in bronchiectasis and is associated with poorer health outcomes. Factors affecting adherence decisions have not been explored in patients with bronchiectasis. Objective: We aimed to explore patients' perspectives on adherence, factors affecting adherence decision making and to develop a conceptual model explaining this decision-making process in adults with bronchiectasis. Methods: Adults with bronchiectasis participated in one-to-one semi-structured interviews. Interviews were audio-recorded, transcribed verbatim and analysed independently by two researchers using thematic analysis. Data from core themes were extracted, categorized into factors affecting adherence decision making and used to develop the conceptual model. Results: Participants' …

Adherence To Treatment In Bronchiectasis: A Challenge That Physiotherapists Can’T Ignore, Amanda Mccullough, Judy Bradley

Amanda McCullough

Adherence to treatment in bronchiectasis: a challenge that physiotherapists can't ignore Summary The purpose of this article is to highlight the importance for physiotherapists of patient adherence to treatment in bronchiectasis. This review provides evidence that adherence is important in bronchiectasis as it is low and affects health outcomes. We also show that there are a number of potentially modifiable factors that affect adherence that could be targeted through adherence interventions. The most effective methods of measuring adherence or interventions to enhance adherence are not known for bronchiectasis. Therefore, future research should focus on developing accurate and simple methods of …

Interventions For Enhancing Adherence To Treatment In Adults With Bronchiectasis (Protocol), Amanda Mccullough, Cristin Ryan, Judy Bradley, Brenda O'Neill, Stuart Elborn, Carmel Hughes

Amanda McCullough

More than 600 million people worldwide suffer from chronic respiratory disease (WHO 2007), leading to 4.2 million deaths annually (WHO 2010). Bronchiectasis is an underdiagnosed and underinvestigated condition; research into new treatments is urgently required to improve the health status of patients with this condition (Gibson 2013). The global prevalence of bronchiectasis is currently not known. The most recent prevalence study, which was conducted in the United States, demonstrated that prevalence of the condition is increasing at a rate of 8.7% annually, with an eight-year prevalence of 1106 per 100,000 of the population (Seitz 2012). Bronchiectasis-associated annual healthcare costs are …

Pharmacist-Led Interventions For Adults With Asthma Or Copd, Cristin Ryan, Amanda Mccullough, Stuart Elborn, Carmel Hughes

Amanda McCullough

Background Chronic lung diseases such as asthma and chronic obstructive pulmonary disease (COPD) are major causes of morbidity, mortality and cost to healthcare service providers globally (WHO 2010). As a result of continued exposure to risk factors, the prevalence of these conditions is expected to increase worldwide. There are approximately 300 million asthma suffers globally, with the prevalence projected to increase by 50% every decade (GINA 2012). COPD is presently the fourth leading cause of chronic morbidity and mortality in the US, and is projected to be the third leading cause of death by 2020 (Mannino 2006).