The impact of AMR and patient support

Why AMR presents a risk to global health

It is important that all stakeholders join forces to prevent 10 million deaths per year by 2050 due to AMR.⁽¹⁾ The implications are both clinical (increased morbidity, mortality, days of hospitalization and development of complications), and economic (longer hospitalization times, disability, etc.).

For this reason, the World Health Organization (WHO) and the European Center for Disease Prevention and Control (ECDC) have set out recommendations, proposing strategies and actions to contain the situation acknowledging the threat posed by AMR as a priority in the health care setting.

The Global Action Plan (GAP) set out 5 objectives to control antimicrobial resistance:

• improve awareness levels through effective information for both health personnel and a general public;
• strengthen surveillance activities;
• improve infection prevention and control;
• optimize the use of antimicrobials in human and animal health;
• support research and innovation.⁽²⁾

The psychological impact of strategies to control antibiotic resistant infections 

Isolation is included among therapeutic strategies for controlling infections in hospital patients. In fact, hospital-acquired infections caused by antibiotic-resistant bacteria are increasingly common around the world. In an effort to contain them, various strategies are implemented such as patient isolation, which can even be preventive in case of high infectious risk. The psychological impact of this measure is certainly significant and very often involves states of anxiety and depression for the patient. This was revealed in a study published in the Journal of Hospital Infection, which examined a population of patients, using specific psychological evaluation scales within 24-48 hours after isolation had commenced.⁽³⁾

According to the researchers, infection control measures do not lead to an increase in anxiety and depression levels only if they are short-term (no more than a week). This is also thanks to the assistance of doctors and nurses; the patient shows a positive and collaborative attitude.⁽³⁾

Besides isolation, other precautionary measures that hospital protocols include, is the use of protective devices (gloves, coats, and masks) for patients and healthcare staff, as well as for visiting relatives. The psychological effects and a perceived reduction in the quality of care are often visible, especially in the most vulnerable people such as the elderly, who tend to feel lonelier and sadder. However, these measures are essential to constrain multi-resistant organisms. A balance must be found between risks and benefits in trying to minimize the patient's discomfort.⁽⁶⁾

The results of a study published in Applied Nursing Research found that hospitalization can negatively affect patients' ability to adapt and their psychological response. Staying in hospital magnifies emotions and promotes anxiety and depressive states due to concern about one's health. These studies attempt to highlight how patients hospitalized with AMR also need to receive psychological and not just medical support during their hospital stay, exploring deficiencies and weaknesses of the hospital system.⁽⁴⁾

Supporting the patient: person-centered care and the right to health care 

There is much talk about patient-centered care (PCC). This health care approach respects the needs, preferences and values ​​of the individual patient, also regarding decisions on therapy and care. It means recognizing and respecting the patient’s values, hopes and reactions beyond the disease and symptoms.⁽⁵⁾ 

In practice, PCC is achieved by providing correct information to the patient, involving them in their care, including the family, and most of all the therapeutic relationship between doctor and patient, which plays an active part in decisions regarding their health.⁽⁵⁾

The implementation of all these activities has often led to positive results, improving the patient's perception of well-being and reducing anxiety and depression. In other words, the individual's ability to cope with illness and hospitalization and to manage emotional states is improved.⁽⁵⁾

However, healthcare organizations face daily shortages regarding economic resources, staff or supplies. As a result, PCC implementation becomes a real challenge for hospitals and healthcare centers.⁽⁵⁾

According to a study published in the BMJ to ensure successful implementation of PCC, determinants that facilitate and obstruct PCC must be investigated and addressed at all levels and types of care. The research identifies three levels: 

• individual (for example, the patient’s personality traits and attitude);
• organizational (for example, goal setting, participation management, resources, infrastructure and corporate culture);
• health system (for example regulations also on patients' rights or political choices at national level).⁽⁵⁾

Developing PCC requires measures and performance that can arise from short-acting strategies (better equipment or design of hospital facilities, including hospital rooms, more patient-friendly) or mid-term or long-term strategies (building a real social culture of patient-focused care).⁽⁵⁾

Another essential aspect is the active involvement and commitment of management, health departments and ministries.⁽⁵⁾

The consequences of AMR: a problem which directly concerns us

Many people and their families have suffered the debilitating effects of antibiotic-resistant infections (AMR). Some did not make it, having lost their lives to these superbugs. Others survived but carried with them the damage of strong and conflicting emotions, such as the fear of not pulling through, though they also felt hope and the desire to look forward to the future. 

It is not without reason that AMR is today an absolute priority in the health sector.

The problem of antimicrobial resistance does not have a single solution, but it must be fought on several fronts, with a joint effort by the institutions and awareness-raising activities aimed at the population. The fight against AMR is not only an individual's but a collective responsibility.⁽¹⁾

MC-ID-44-2023