Antimicrobial stewardship programs in Italy: structure, process and outcome indicators, 2017-2019

Abstract Background The increasing spread of antimicrobial resistance (AMR) represents a global public health threat, and a significant challenge for healthcare delivery. Antimicrobial stewardship (AMS) programs have proven to be effective and cost-effective strategies for optimizing antimicrobial use. We aimed to assess key aspects of AMS programs implemented in acute-care trusts of the region of Piedmont, and to evaluate changes in antimicrobial usage against a score we attributed to structural and functional elements of AMS programs. Methods AMS programs operating in acute-care trusts in the region of Piedmont were investigated via a survey addressing program characteristics, divided into structure and process quality indicators. All public health trusts of the region of Piedmont were invited to complete the survey. The indicators were selected based on core elements identified by international guidelines and were reviewed by a multi-disciplinary panel. Antimicrobial usage was expressed as defined daily doses, DDD per 1000 patient-days. The annual means for the years 2017-2019 were considered, as well as the percentage change between 2017 and 2019. Variables were investigated in relation to structure and process scores using Spearman correlation. Analyses were performed using SPSS v. 27.0 (SPSS Inc., Armonk, NY). Results In total, 25 AMS programs were surveyed. Higher scores were achieved for process rather than structure indicators. Improvements in total antimicrobial usage (-4%) were found between 2017 and 2019. A moderate correlation was found between structure score and percentage change in antimicrobial usage (Spearman’s ρ -0.603, p 0.006). Conslusions This study highlighted important areas for improvement, such as accountability, microbiological laboratory quality management and feedback. Repeated measurements of structure, process and outcome indicators will be important to guide continuing quality improvement efforts. Key messages • Results of this study support the effectiveness of AMS programs in reducing antimicrobial use. • Important areas for improvement were identified. Improving the organization of AMS programs in particular should be prioritized.


Background:
The increasing spread of antimicrobial resistance (AMR) represents a global public health threat, and a significant challenge for healthcare delivery.Antimicrobial stewardship (AMS) programs have proven to be effective and cost-effective strategies for optimizing antimicrobial use.We aimed to assess key aspects of AMS programs implemented in acute-care trusts of the region of Piedmont, and to evaluate changes in antimicrobial usage against a score we attributed to structural and functional elements of AMS programs.Methods: AMS programs operating in acute-care trusts in the region of Piedmont were investigated via a survey addressing program characteristics, divided into structure and process quality indicators.All public health trusts of the region of Piedmont were invited to complete the survey.The indicators were selected based on core elements identified by international guidelines and were reviewed by a multi-disciplinary panel.Antimicrobial usage was expressed as defined daily doses, DDD per 1000 patient-days.The annual means for the years 2017-2019 were considered, as well as the percentage change between 2017 and 2019.Variables were investigated in relation to structure and process scores using Spearman correlation.Analyses were performed using SPSS v. 27.0 (SPSS Inc., Armonk, NY).

Results:
In total, 25 AMS programs were surveyed.Higher scores were achieved for process rather than structure indicators.Improvements in total antimicrobial usage (-4%) were found between 2017 and 2019.A moderate correlation was found 15th European Public Health Conference 2022

Background:
Research shows that vaccine-related beliefs (i.e., about efficacy, safety, purpose) may reflect a host of within-person and contextual factors yielding homogeneous subgroups of individuals.This study aims to characterize distinct subgroups of people and identify ideal targets for tailored public health interventions to increase vaccine adherence.Methods: Latent class analysis was used to derive subgroups based on unique response profiles using the 2019 Gallup survey of 140 countries (>140,000 individuals).We modeled a composite of vaccine beliefs as a distal outcome examining differences for the obtained classes, with and without covariates in the model.

Results:
A 5-class model fit best with classes distinguished primarily on whether individuals possessed or sought personal knowledge about science, medicine, and health, whether they trusted science, scientists and have confidence in the healthcare system.The lowest levels of vaccine beliefs were reported by a class not endorsing any of these indicators and the highest levels by a class endorsing all the indicators (p < 0.001).Age class showed a U-shaped relation with vaccine beliefs, while higher educational level (p = 0.025), higher subjective income (p = 0.006) and employment (p < 0.001) were related to higher vaccine beliefs.Country-level income was moderately related to class membership and vaccine beliefs were higher in lower-income countries (p < 0.001).

Conclusions:
Our findings suggest that more work is needed to improve trust in science and medical providers.Tailored interventions grounded in a community-based and empowering approach with the collaboration of multiple stakeholders seems to be needed to improve vaccination rates.This can only be achieved when individuals trust science, scientists and healthcare providers and accrue the necessary wisdom to make good healthcare decisions that affect not only themselves but their fellow citizens.

Key messages:
Efforts to alter vaccine beliefs should touch on where people access information on science and health, the processes that build trust, and their belief whether science improves wellbeing.
Public health interventions should focus on reassuring individuals that science and health workers are benevolent.An essential first step in the health worker-patient relations is building trust.