Deidre and Dan Policy Paper

Dan Foreman
Deidre Hinkeldey
Policy Paper
Background:
Antibiotic resistance occurs when a bacterial cell randomly mutates its structure to resist the effects of the antibiotic. Physicians are often prescribing antibiotics to patients who might not have a bacterial infection or really don’t (avoid contractions) need the drug. Physicians are also behind the inappropriate use of antibiotics in cases where they prescribe antibiotics to patients with a viral infection. A study (what study) illustrated that a cause of increased antibiotic prescribing over time may be due to the physicians yielding to patient demands for antibiotics. In today’s society many people want a quick fix for their problems. Physicians with a higher practice were said (where did they say this) to prescribe antibiotics for a viral infection more than a less experienced physician. Also, more second and third line antibiotics are being used as first line treatment, resulting in more antibiotic resistant drugs. Inappropriate antibiotic prescribing from the higher practiced physicians is a result of avoidance of time-consuming patient education (1). This shows that physicians need to spend more time with patients as well to figure out the appropriate diagnosis(reword???). Overuse of antibiotics is widespread across geographical areas, medical specialties, and payment sources. Therefore, effective strategies for changing prescribing behavior for these conditions will need to be broad based (5).
The overuse of antibiotics is one of the main reasons as to why antibiotic resistance has become a problem in the medical world. A study completed in Canada was done to show the number of antibiotic prescriptions that were reduced because of the realization that they were unnecessary. The number of antibiotic prescriptions per 100 inhabitants changed by 26.5% down to 19.6%, showing close to a number of 7 patients that received unnecessary prescriptions (3). In 1998 55% of all antibiotics that were given to treat expected respiratory bacterial infections costed(???) 726 million dollars (5). The inappropriate use of antibiotic agents creates an environment for the development of resistance, placing both the community and individual patients at risk (2). Antimicrobials were just introduced a little over sixty years ago and since then resistant strains of bacteria have already arisen due to over usage of antibiotics. If something isn’t done about this situation soon we may be in a pre-antibiotic age again (4).
Policy:
As directors of the Iowa Department of Public Health, we are planning a policy to implement by January of 2011 that concerns all primary care physicians and nurses, including outpatient and hospital settings. The policy states that in order to prescribe antibiotics to a patient there must be evidence of a bacterial infection. In order to determine if there is a bacterial infection the nurse/physician would gather a specimen and perform a test to check for infection. The type of testing would depend on the patient situation. If a viral infection was found from the test, the physician would have to determine other measures to approach since an antibiotic is out of the question. This policy would also affect the nurse assessing the patient before the doctor talks with the patient. The nurse would be required to fully assess the problem, note symptoms, abnormalities, and previous health history including medications the patient is taking. In the health history, the nurse would note on what type, if any, of antibiotics the patient has taken in the past and what the dosage was. All of these procedures must be completed regardless of how long it may take in order to allow for a more accurate diagnosis of the problem and better detection if a test is needed for infection. This allows for the nurse to spend more time with the patient and focus on patient education on prevention of infections through a healthy lifestyle. An exception for this policy would be is if a patient is in a life threatening situation and the doctor believes an antibiotic would be beneficial, then no testing would need to be used. We will enforce this policy by requiring physicians to test 90% of all patients for bacterial infection. When a physician prescribes antibiotics they must fill out paper work with the reasons why they prescribed a specific antibiotic. The physicians are required to turn in all paper work concerning antibiotics to the Iowa Department of Public Health. Failure to document will result in a three strike program. The first strike the physician will receive a warning, the second strike will result in a fine, and the third will result in a fine and a suspension that would be determined by the Iowa Department of (Public) Health. The IDPH will have a beginning fund of $5000 put towards the extra testing required or any extraneous costs, and would from then on be funded partially by insurance companies, fines from physicians for failure to follow policy, and random fund raising projects done across the state.
Conclusion:
Limited amount of physicians available and the amount of time they work in a week may be a problem noted with this policy. The time and testing that each physician uses concerning the patient will result in improved accuracy of prescribing antibiotics. Requiring only 90% of the patients to be tested may be a concern found with the policy. Those that aren’t tested are still fully assessed and educated on healthy life styles. By the implementation and enforcement of this policy it is hoped that the inappropriate and unnecessary prescriptions of antibiotics can be reduced, resulting in a decline in antibiotic resistance. It is also hoped by the education each patient receives contributes to a nationwide knowledge about the effects of antibiotic resistance to our communities.

Bibliography
Cadieux, Genevieve, Robyn Tamblyn, Dale Dauphinee, and Michael Libman. "Predictors of inappropriate antiobiotic prescribing among primary care physicians." CMAJ-JAMC 177.8 (2007): 877-883. Web. 29 Sep 2009.
Mainous III, Arch, William Hueston, Matthew Davis, and William Pearson. "Trends in Antimicrobial Prescribing for Bronchitis and Upper Respiratory Infections Among Adults and Children." American Journal of Public Health 93.11 (2003): 1910-1914. Web. 29 Sep 2009.
Sabuncu, Elifsu, Julie David, Sophie Pepin, Michael Leroy, and Laurence Watier. "Significant Reduction of Antibiotic Use in the Community after a Nationwide Campaign in France, 2002-2007." Public Library of Science Medicine 6.6 (2009): e1000084. Web. 29 Sep 2009.
Hawkey, P M. "Molecular epidemiology of clinically significant antiobiotic resistance genes." British Journal of Pharmacology 153.S1 (2008): s406-s413. Web. 29 Sep 2009.
Gonzalez, Ralph, John F. Steiner, and Merle A. Sande. "Antibiotic Prescribing for Adults With Colds, Upper Respiratory Tract Infections, and Bronchitis by Ambulatory Care Physicians." Journal of the American Medical Association 278.11 (1997): 901-904. Web. 1 Oct 2009.bold text

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License