CHAMP - Changing behaviour of healthcare professionals and the general public towards a more prudent use of anti-microbial agents

EC contribution: : € 1.445.260
Duration: : 36 months
Starting date: : 01/07/2007
Funding scheme: : Specific Targeted Research Project
Keywords: : antibiotics, appropriate use, behavioural programs, respiratory tract infections
Contract/Grant agreement number: : SP5A-CT-2007-044317
Project web-site: : -

Background:

The aim of CHAMP is to promote the appropriate use of antibiotics by developing effective tools to change behaviour of health care professionals, patients in primary care, and the general public on the prescription and use of antibiotics.

Effective interventions in this field should take into account cultural differences between countries and be based on knowledge of perceptions and behaviour of medical professionals, patients and the general public within the European Union. Therefore the first stage of the project will explore current prevention and management of respiratory tract infections in European primary care and perception, expectations and illness behaviour of primary care patients with respiratory tract infections.

Then an up-to-date inventory of both published and unpublished public campaigns and behavioural programs will be made and qualitative information from key-players and stakeholders in this field will be gathered. Cost-effectiveness of the different interventions used until now will be modelled. In addition, information will be gathered systematically on educational programs from medical schools on prevention and management of common respiratory tract infections.

The information thus gathered will be analysed and priorities chosen. Consensus will be aimed for among experts and stakeholders on tools to improve the behaviour of medical professionals and the public concerning prevention and management of infectious diseases and antibiotic use. In addition, standard procedures will be developed to measure the effects of educational activities, behavioural programs and public campaigns in this field. Finally, the implementation of the behavioural program that is thus developed will be tried out and evaluated in six GP networks in six different countries. This will be done in close collaboration with the GRACE project.

Problem:

Antibiotics are priority drugs and bacterial resistance is a major public health issue (http://mednet3.who.int/prioritymeds). Antibiotic consumption is a key driver of resistance, although the relationships are complex. In Europe, antibiotic consumption varies from approximately 10 defined daily doses (DDD) per 1000 inhabitants and day in the Netherlands to 32 DDD per 1000 inhabitants and day in France. (Goossens et al Lancet 2005;365: 579-587).

Besides the strengthening of surveillance systems on antimicrobial resistance and the use of antimicrobial agents and other preventive measures (such as regulations for prescription-only use of antibiotics) the European Commission regards the education and training of healthcare professionals on the topic of antimicrobial resistance and the informing of the public as major tools to achieve a more rational, evidence-based use of antimicrobial agents in human medicine . For this reason the European Commission has called for proposals focussing on the development of tools for behavioural changes of the general public and healthcare professionals towards a more prudent use of antimicrobials.

Several types of interventions and campaigns are described in the literature. Public campaigns are large scale activities aiming at the public in general, usually using mass media to communicate with the target group. Behavioural programs are usually targeted at a specific group of medical professionals or patients. In clinical settings these behavioural programs are sometimes also called quality assurance programs, referring to the aim of these projects at improving and monitoring quality of care. Both public campaigns and behavioural programs can of course be seen as interventions aiming at changing attitude, behaviour and expectancies and will be addressed in this project.

The vast majority of antimicrobial agents is used in ambulatory patients in primary care. The two major groups of infectious diseases for which antimicrobial therapy is given outside hospitals are respiratory tract infections and urinary tract infections. Overuse of antibiotics is most prominent in respiratory tract infections that are usually mild and of viral origin. At this moment there is no clear overview of the effects of interventions aimed at a more rational use of antibiotics in primary care. Such an overview and analysis of determinants of success and failure are of paramount importance to develop and implement future European strategies in this field.

Aim:

The aim of CHAMP is to promote the appropriate use of antibiotics by developing effective tools to effect behavioural changes of health care professionals, patients in primary care, and the general public on the prescription and use of antibiotics. This will be done by executing seven workpackages which have the following objectives:

Workpackage 1
Management and coordination

Workpackage 2
To describe management of LRTI and selected other common infections in Europe and to achieve a deep understanding of variation in management of these infections.

Workpackage 3
To perform a systematic review of public campaigns on improving antibiotic use and the uptake of immunisation programs in high-income countries (Europe, America, Asia, Australia)

Workpackage 4

To provide a systematic review of behavioural interventions aimed at primary care patients in terms of their specific features (duration, costs, type of strategy, conceptual basis) and outcomes (e.g. attitudes, intensions, expectation for antibiotics, consumption of antibiotics)
To provide a systematic review of behavioural interventions aimed at medical professionals in terms of their specific features (duration, costs, type of strategy, conceptual basis) and outcomes (e.g. attitudes, intensions, quantity and quality of antibiotic use, costs, adverse outcomes, sustained effects, resistance rates).
To explore the views of researchers, medical professionals, patients and policy makers in Northern, Southern and Eastern Europe on quality assurance and behavioural programs on rational antibiotic use in primary care
To review national and international guidelines on lower respiratory tract infections, acute sore throat, sinusitis and otitis media.

Workpackage 5
To generate economic evidence to inform policy and practice about tools to change the behaviour of the general public and professionals with regard to unnecessary antibiotic use.

Workpackage 6

To compare effectiveness and cost-effectiveness of public campaigns and behavioural programs.
To reach consensus among experts on tools to improve the behaviour of medical professionals and the public concerning management of infectious diseases and antibiotic use
To compare contents and methods information on educational programs from medical schools and vocational programs in primary care from the 11 countries participating in the GRACE project on prevention and treatment of respiratory tract infections,
To develop a European medical school curriculum on prevention and treatment or respiratory tract infections in primary care.
To develop a system to evaluate public campaigns, behavioural and educational activities on evidence based management of respiratory infections in Europe.

Workpackage 7
To explore problems related to the implementation of the CHAMP behavioural program aiming at a more rational use of antibiotics in three different European regions (six countries)

Expected and obtained results:

CHAMP will produce an inventory of attitudes and expectations of both health care professionals and patients in primary care on antibiotic treatment in respiratory and urinary tract infections. In addition it will provide a state-of-the-art overview of behavioural interventions and public campaigns on antibiotic use and determinants of success and failure. Experts will formulate an evidence based advice to the Commission on the preferred policy in order to improve antibiotic use in European primary care. In addition it will evaluate important issues related to implementations of such a policy.

Potential applications:

The Champ final report can be used to formulate future European policy in this field and can also be a basis for national and regional strategies.

Coordinator:

Prof. Th.J.M. Verheij
Julius Center for Health Sciences and Primary Care
University Medical Center Utrecht
PO Box 85500
3508 GA Utrecht, Netherlands
Tel. +31 887568188
Fax: +31 88 7568099
th.j.m.verheij@umcutrecht.nl

European Commission