Impact of Social, Economic, and Healthcare Factors on the Regional Structure of Antibiotic Consumption in Primary Care in Poland (2013-2017).

Antibiotic resistance is one of the most important public health threats worldwide. Antimicrobial misuse and overuse are well-recognized risk factors for the resistance emergence and spread. Monitoring of antibiotic consumption (AC) is an important element in strategies to combat antibiotic resistance. As a result of AC surveillance in Poland, regional differences in AC levels were observed. This study aimed to characterize the regional AC in the period 2013-2017 in primary care in Poland and to assess the possible determinants that influence the AC at the regional level. The study analyzed relationships between AC and its factors (grouped in three different categories: demographic, economic, and related to the organization of healthcare). Data covered AC in primary care in 5 years period (2013-2017) from all 16 Polish voivodeships. The AC primary care data were sales data, expressed in defined daily doses (DDD) according to the WHO methodology. The yearly data on demographic, economic, and related healthcare factors were downloaded from the Central Statistical Office of Poland. Standard statistical parameters were used to characterize the AC. Non-standardized regression coefficients were used to estimate the quantitative dependence of variables. The strongest correlation was demonstrated with factors related to employment, female reproductive activity, mobility of the population, the number of outpatient consultations, and the number of dentists. A correlation was also found between population mobility and density. Recognized risk factors for increased AC should be a priority for interventions implementing and disseminating rational antibiotic policy.

Monthly trends in antimicrobial consumption and influenza incidence at the community level in 2014 in Poland.

INTRODUCTION Antibiotic resistance is nowadays one of the most important public health threats. It is mainly caused by inappropriate antibiotic usage. OBJECTIVES We aimed to characterize the seasonal trends of antimicrobial consumption (AC) and to assess the possible relation between AC and the incidence of influenza at the community level in 2014 in Poland. PATIENTS AND METHODS Influenza incidence, AC, and the number of inhabitants vaccinated against influenza were examined at the community level. The AC was assessed on the basis of sales data and then converted to defined daily doses (DDDs) per 1000 inhabitants per day according to the Anatomical Therapeutic Chemical Classification System and the DDD methodology. The data on the incidence of influenza and influenza-like cases were based on notifications from primary care doctors. RESULTS The majority of antimicrobials were consumed at the community level. The mean community consumption of antibacterials for systemic use in Poland in 2014 was 22.50 DDDs per 1000 inhabitants per day. The most frequently consumed substances were oral amoxicillin, amoxicillin and enzyme inhibitor, and cefuroxime. Two seasonal peaks of AC were observed. Seasonal trends in AC were similar to trends in influenza incidence. The highest AC was observed in a voivodeship with the highest influenza incidence. CONCLUSIONS The extent of outpatient AC and the seasonal coincidence of influenza and AC pose an important risk for antibiotic overuse and misuse, which are the main causes of antibiotic resistance.

What are school children in Europe being taught about hygiene and antibiotic use?

e-Bug is a pan-European antibiotic and hygiene teaching resource that aims to reinforce awareness in school children of microbes, prudent antibiotic use, hygiene and the transmission of infection. Prior to the production of the resource, it was essential to examine the educational structure across each partner country and assess what school children were being taught on these topics. A questionnaire was devised for distribution to each European partner (Belgium, Czech Republic, Denmark, England, France, Greece, Italy, Poland, Portugal and Spain), exploring their educational structure and examining educational resources or campaigns currently available. From the data collected it was evident that the majority of European schools have structured hand hygiene practices in place from a young age. The curricula in all countries cover the topic of human health and hygiene, but limited information is provided on antibiotics and their prudent use. School educational resources that link to the national curriculum and implement National Advice to the Public campaigns in the classroom are limited. The Microbes en question mobile health education campaign in France is an example of a successful children's education campaign and an innovative programme. Evaluation of the impact of school education on attitude and change of behaviour is also limited throughout many European countries. Not enough is currently being done across Europe to educate school children on the importance of appropriate antibiotic use and antibiotic resistance. The data from this research were used to develop e-Bug, a European Union-funded antibiotic and hygiene teaching resource.

Development of an educational resource on microbes, hygiene and prudent antibiotic use for junior and senior school children.

Health promotion interventions aimed at children and young people have the potential to lay the foundations for healthy lifestyles. One such intervention, e-Bug, aims to provide schoolchildren with knowledge of prudent antibiotic use and how to reduce the spread of infection. Many children and schools approach learning in different ways; therefore, it is essential to research school needs and the variety of learning styles when creating any school resources. This article outlines the process involved during the development of a pan-European educational resource, and identifies the final pack layout, based on feedback from teacher focus groups, student questionnaires and European partner discussions.

Overview of e-Bug: an antibiotic and hygiene educational resource for schools.

Antibiotic resistance is an increasing community problem and is related to antibiotic use. If antibiotic use could be reduced, the tide of increasing resistance could be stemmed. e-Bug is a European project involving 18 European countries, partly funded by The Directorate-General for Health and Consumers (DG SANCO) of the European Commission. It aims to develop and disseminate across Europe a junior and senior school teaching pack and web site (hosting the lesson plans and complementary games) that teach young people about prudent antibiotic use, microbes, transmission of infection, hygiene and vaccines. The aim of e-Bug is to increase young people's understanding, through enjoyable activities, of why it is so important to use antibiotics correctly in order to control antibiotic resistance, and to have good hand and respiratory hygiene to help reduce the spread of infection. Within the senior school pack the sexual transmission of infections has also been included, as the peak age of chlamydial infection is in 16-24 year olds. Teachers, young people and the consortium of 18 countries were closely involved with agreeing learning outcomes and developing the resource activities. Young people helped create the characters and microbe artwork. The resources have been translated, adapted for and disseminated to schools across 10 countries in Europe, and endorsed by the relevant government departments of health and education. The web site has been accessed from >200 countries. The resources will be translated into all European Union languages, and have been used to promote European Antibiotic Awareness Day and better hand and respiratory hygiene during the influenza pandemic in 2009.

Developing e-Bug web games to teach microbiology.

As a complement to the e-Bug teaching pack, two e-Bug games were developed to provide content that aimed to entertain as well as to educate. A set of agreed learning outcomes (LOs) were provided by the scientific partners of the e-Bug Project and the games were developed using user-centred design techniques (the needs, wants and limitations of the potential game players were assessed at each stage of the design process). The e-Bug games were designed for two age groups: Junior (9-12 year olds); and Senior (13-15 year olds). A study using focus groups was done to gain an understanding as to the types of games enjoyed by the target users. According to the preliminary study, the Junior Game was developed as a platform game and the Senior Game was developed as a story-based detective game. The Junior Game consists of five levels, each associated with a set of LOs. Similarly, the Senior Game consists of four missions, each comprising five stages using problem-based learning techniques and LOs. In this paper, the process of development for each game is described in detail and an illustration is provided of how each game level or mission addresses the target LOs. Development of the games used feedback acquired from children in four schools across the UK (Glasgow, London and two in Gloucester). The children were selected according to their willingness to participate. European Partners of the e-Bug Project also provided further support, translation and requests for modifications. The knowledge gained of LOs and further evaluation of the games is continuing, and preliminary results are in press. The final versions of the games, translated into 11 European languages, are available online via www.e-bug.eu.

Progress towards implementing the e-Bug Project in Poland.

The e-Bug Project provides useful educational tools that can be implemented in primary and secondary schools, and plays important role in reducing the burden of community-acquired infections. Consideration of the Polish education system and educational programmes in schools facilitated the selection of the best age groups for the implementation of e-Bug materials in Poland. The Polish version of the resources has been reviewed by a special group of experts and teachers from pilot schools. The pilot implementation is currently provided by demonstration lessons for educators and recorded as a demonstration material. The e-Bug teaching pack is a valuable resource that is useful for improving knowledge about microorganisms, hygiene and antimicrobial agents, and is aimed at pupils, teachers and parents.

Hospital antibiotic management in Poland--results of the ABS maturity survey of the ABS International group.

BACKGROUND: The increasing incidence of antibiotic resistance is a serious worldwide problem, as underlined by European Union documents. The project ABS International has been appointed to identify strengths and weaknesses of hospitals with regard to issues related to antibiotic policy. METHODS: The questionnaire "ABS hospital mature" was developed within the study to analyze the ABS-related maturities in nine member states of the EU. Several fields of antibiotic strategy in hospitals were explored. In Poland the questionnaire was sent to over 100 hospitals and the responses were delivered to the National Medicines Institute (the project representative in Poland) via the internet. MAIN FINDINGS: The hospitals involved represented three referral levels according to services provided. Within the hospital, the questionnaire was filled out by a microbiologist or an infectious disease specialist. Within the examined fields there were no serious differences between the referral levels. Microbial diagnostics obtained the highest score, whereas "antibiotic-related relationships" and "antibiotic-related personnel development" ranked lowest. Maturity in the field of the antibiotic strategy differs among Polish hospitals. The highest score in the general assessment was assigned to hospitals at secondary referral level. Knowledge on issues of antibiotic resistance and microbiological services and procedures obtained the highest score but its implementation was not sufficient. CONCLUSIONS: Results suggest a need to increase the number of specialists in antibiotic usage and policy, and to improve collaboration within and between hospitals.