Debra A. Goff, PharmD, FCCP: Thank you for joining us today for this Contagion® program. The overuse and misuse of antimicrobials is a pressing issue in the healthcare setting. Antimicrobial stewardship programs coupled with social media are poised to educate and engage the world in the appropriate and responsible use of antimicrobials to improve outcomes and mitigate an escalation in resistance to these therapeutic agents.
I’m Dr. Debbie Goff, an infectious disease clinical pharmacist at The Ohio State University Wexner Medical Center.
John Nosta, BA: Hi, I’m John Nosta. I’m a health technology strategist and a contributor for Forbes. My job is to look at how technologies interface with clinical medicine to provide optimal solutions to reach patients, caregivers, and clinicians around the world.
Debra A. Goff, PharmD, FCCP: Thank you, John. So today we’re going to have an important discussion about antimicrobial stewardship and the role of social media. Let’s get started.
You know, I look at social media. Why is it important to me, as a clinician? There are so many reasons. It gives me the opportunity to engage, educate, connect, and network, literally with experts and consumers and patients around the world. That’s an opportunity that no other vehicle provides. So John, why is it important to you?
John Nosta, BA: I have this inclination to reach into my pocket and pull out my phone and check Twitter or tweet this moment. Clearly it allows us to know what’s going on in the world with a surprising heft of content. But when I think about it, when we talk about antimicrobial stewardship, it’s such a complicated topic. It’s a life-or-death topic, in many instances. I guess for me, and we’re going to get into this, Twitter feels trivial. It’s something for the Hollywood stars.
Let’s kind of set the ground on antimicrobial stewardship in the world today. How do we do it? It’s such a complicated question. Let’s grab it.
Debra A. Goff, PharmD, FCCP: We’ve been doing it for years—over a decade. I always say that if it was as simple as reading a guideline or an article, the world would be successful. But we’re not. We’ve made great progress, but we don’t have everybody fully engaged. It’s so complex. It’s not just the healthcare provider that needs to be onboard. We need to have patients onboard. They pressure us for antibiotics because they think they’re feel-good medicine. They solve problems quickly. But the consumer doesn’t understand some of the basics of science, such as that antibiotics don’t work for viruses. When you see a cold, people ask us for medications, antibiotics, and it’s just not appropriate. But doctors are evaluated. We have patient-satisfaction scores, and people go on social media and make bad reviews on Yelp.
John Nosta, BA: The satisfaction score that a patient provides to a physician is often a function of getting the script.
Debra A. Goff, PharmD, FCCP: Right.
John Nosta, BA: If I go to a dermatologist and the dermatologist says, “Just go to CVS and buy hydrocortisone,” I’m disappointed.
Debra A. Goff, PharmD, FCCP: Exactly. And there lies the problem.
John Nosta, BA: So help me understand the dimensionality of appropriate use. We have the patient—and Twitter, social media, consumer empowerment—and they want to know what they’re doing. They want to have a hand in that—collaborative care, as we say.
Debra A. Goff, PharmD, FCCP: Sure.
John Nosta, BA: So if you look at this kind of broadly, where does it align? Is it an office space problem? Is it a problem in the intensive care unit with a nosocomial pneumonia? Is it a surgical scenario? Is it a little bit of everything? Does it stack up one way or another?
Debra A. Goff, PharmD, FCCP: So you could just keep going, and I’d say, “John, it’s all of the above.”
John Nosta, BA: OK.
Debra A. Goff, PharmD, FCCP: That’s what makes it so hard. I work in the hospital setting, and I used to think, when I started, that if I could just get antibiotics to be used appropriately in my hospital, I’d have half of the problems solved.
John Nosta, BA: What does that mean: appropriately? Let’s define that. Let’s start at the very beginning.
Debra A. Goff, PharmD, FCCP: Sure. The Centers for Disease Control and Prevention has already told us, and they’ve done amazing studies, that 30% of antibiotics prescribed in the outpatient setting are inappropriate. This means they’re not even necessary. Or we choose to prescribe an antibiotic for an uncomplicated urinary tract infection [UTI], which actually is just colonized bacteria. A patient is not truly infected, and we will just treat a culture.
John Nosta, BA: Really?
Debra A. Goff, PharmD, FCCP: Yes. And so that’s not an appropriate use.
John Nosta, BA: But it hurts. If I’m a patient with a UTI…
Debra A. Goff, PharmD, FCCP: If the patient is symptomatic, that’s probably a true infection. But asymptomatic bacteriuria lead to the most common overuse and misuse of an antibiotic in the hospital setting.
John Nosta, BA: How do they find the bacteriuria?
Debra A. Goff, PharmD, FCCP: A culture. And now they feel compelled to treat a lab result, but it’s actually not that simple. You have to look at the patient and put the whole clinical scenario together. So that’s the No 1 cause of overuse in a hospital setting. But it doesn’t stop there, to get back to your point.
We know about outpatient prescribing. For respiratory tract infections, if the patient comes in sniffling and sneezing and wants an antibiotic because they think that’s what’s going to treat them, the physician is more likely going to give them that antibiotic. It’s sort of feel-good medicine. “I’m going to make you happy, and you’re going to like me. And therefore I’m going to do this.” But it’s actually inappropriate to do that if the patient does not have a bacterial infection.
John Nosta, BA: You know, it’s, “I want my MTV.” It’s “I want my Z-Pak.”
Debra A. Goff, PharmD, FCCP: Right. That’s exactly what they say.
John Nosta, BA: Yes.
Debra A. Goff, PharmD, FCCP: So that is the behavior that we have to change. Antibiotic stewardship is more than just trying to teach the appropriate use of antibiotics. It’s about behavior change. For 30 years, you’ve prescribed this. Now I’m going to try to tell you that you’re potentially causing more harm because you’re helping to create antibiotic resistance. The world is running out of effective antibiotics. You have to stop doing that. I’m trying to change your behavior. I always tell antibiotic stewards that’s the psychiatry degree I forgot to get. Now I have to be able to influence and change your behavior, and that’s really hard.