Original ResearchRe-thinking risk communication: information needs of patients, health professionals and the public regarding MRSA – the communicative behaviour of a public health network in Germany responding to the demand for information
Introduction
Antimicrobial resistance and health care associated infections (HCAIs) are major topics on health policy agendas in countries across the world.1, 2, 3, 4 The Chief Medical Officer in the UK, Professor Dame Sally Davies, recently described the threat posed by antimicrobial resistance as ‘catastrophic’ and put it on the same level of seriousness as international terrorism.5 The rise in meticillin-resistant Staphylococcus aureus (MRSA) infections represents a nexus between two important problems: health care associated infections and antibiotic resistant bacterium. With patients increasingly travelling to other countries for treatment and the growth of cross border health care, the prevalence of MRSA and other multidrug resistant organisms (MDRO) has developed a pan-European dimension which must be combated in order to ensure consistent quality of care and safeguard patients.6, 7, 8
Previous research has investigated the information needs of patients and health care professionals with regards to different diseases and when choosing between health care providers.9, 10, 11, 12 Public health authorities (PHAs) are deemed to be in a unique position to communicate with health care professionals, patients, the public and other stakeholders about health risks and in turn can offer advice regarding infection control. They are also in the position to advise both patients and health professionals regarding treatment and provide evidence-based recommendations to aid the smoothness of patients' journeys through the different parts of the health care system (home, primary care, secondary care, long term care).
The potential for movement within as well as across these different sectors, within and across different countries, has been highlighted as a major risk factor for increasing the spread of infections such as MRSA.13, 14, 15 This led some to call for the urgent creation of professional networks to support the coordination and structure of care for patients with MRSA within countries, in cross-border regions and internationally. In response, the German federal ministry of health decided in 2006 to develop regional MDRO networks across the country.16, 17 In the Rhine-Main region, a MDRO network of nine PHAs was founded in 2010, covering around 250 participating organisations (e.g. medical institutions, long term care facilities, various organisations for patient transport). One of the services provided by the network is a helpdesk offering advice to health care professionals, patients and the wider public. One qualified study nurse is in charge of the helpdesk answering calls during opening hours. During out-of-hours an answering machine records the entries and calls are returned the next day. Only in times of absence (e.g. vacation), a second study nurse replaces the person in charge. Both nurses have access to a network of physicians, microbiologists and experts in antibiotic therapy.
At the time of the study, only around two or three other networks offered personal information services to patients or relatives. The helpdesk has a unique position as information service for both professionals and lay-people alike and is embedded in network activities with frequent meetings and contacts with network members.
The helpdesk provides a high competent person at first contact to answer the questions or provide another service. This helpdesk was created as members of the public health authority perceived a lack of information and evidence-based recommendations for specific situations. The helpdesk is paid for by a grant from the ministry of health for a period of five years (2010–2015).
Information and communication are considered vital activities in the prevention and management of infectious diseases.11 Previous research stress the importance of engaging with patients and providing information.18, 19 However, commentators on health communication, and risk communication in particular, are beginning to focus less on the role of scientific fact provision and instead emphasise the importance of social elements of communication such as relationship and trust building.20, 21, 22 The evidence base for the recommendation of risk communication strategies is still limited.22 Empirical studies analysing the communicative behaviour of public health authorities are much needed if measures to prevent and manage infectious diseases are to be improved.
This article looks at who are the main users of PHA/MDRO network information helpdesks, what information they most commonly request regarding MRSA, the means by which they were made aware of the service and the communicative behaviour of PHA responding to their requests. We also investigated the media's influence on service use. By investigating information needs and communicative behaviour, we hoped to identify ways by which communication of health care related information might be improved in the future.
Section snippets
Methods
The helpdesk provided a database of 577 recordings of calls featuring questions about MRSA from between May 2010 and May 2012. The raw data included information on the type of caller (patient, health care professional etc.), their location, the affected party, to whom the request related, the means by which they came aware of the helpdesk and the content of their request. The recordings were assessed for eligibility by applying predetermined criteria. After this initial screen, 501 recordings
Distribution of calls
While the distribution of different callers remain roughly the same, the monthly calls increase from 18 in 2010 to 22 in 2011 and 33 in 2012 (Table 1).
Caller groups
Three different caller types were identified: doctors, nurses (in care homes), and private individuals (patients and their relatives). In 2010, 58% of questions to the helpdesk came from private individuals, 31% were asked by doctors and 11% by nurses. In 2011, the share of calls coming from doctors fell to around 20% at the same time as calls
Thematic distribution of questions
The results of our analysis show that health care professionals (both doctors and nurses) as well as patients and relatives contact the MDRO network helpdesk, with a high level of consistency in terms of the questions. While the distribution of different callers remains roughly the same, the monthly calls increase. We understand this increase of calls as a sign for acceptance, increasing popularity and proof of usefulness of the helpdesk.
Ethical approval
As we re-analysed a pre-existing database, ethics approval was not considered necessary.
Funding
This research was funded by European Commission 7th Framework Programme (FP7 – 2007-2013) under Grant Agreement 242058, EUCBB (European Union Cross Border Care Collaboration).
Competing interests
The authors declare that they do not have a conflict of interest. PD did this research during her fellowship at the London School of Economics (LSE) and has since 2013 set up her own consultancy on strategic risk communication. There
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