Kathryn Hoffmann

Antibiotics and their effects: what do patients know and what is their source of information?

BACKGROUND The Eurobarometer 2010 report on antimicrobial resistance included a survey on the knowledge of Europeans about antibiotics. Austria was ranked at the bottom of the EU27 countries. Based on these alarming results, it was the aim of this study to analyse demographic characteristics of patients and general practitioners in Austria to assess possible predictors for this outcome as well as to assess the main source of information related to antibiotics. METHODS This cross-sectional study was conducted within the context of the European APRES project. An additional 12-item questionnaire was developed asking for the knowledge about antibiotics, demographic data and the source of information. Statistical analyses included subgroup analyses and linear mixed regression models. RESULTS Overall, 3280 questionnaires were analysed. On average, 2.78 (standard deviation 1.69) out of the six knowledge questions were answered correctly. The main predictors for a low knowledge score were low educational level, age, speaking another language than German and male sex. In all, 55.6% of the participants marked the general practitioner as main source of information. However, the source was less important for the knowledge score than their highest educational level. CONCLUSION The Eurobarometer report result for Austrians could be confirmed and important associations and predictors could be identified: a multifaceted and evidence informed strategy is needed to improve the situation, which should both focus on target-group-specific interventions at the individual level to increase the knowledge of people with the highest needs as well as on strengthening the primary health care and educational sector at the system level.

Access points to the different levels of health care and demographic predictors in a country without a gatekeeping system. Results of a cross-sectional study from Austria.

BACKGROUND The challenges for health care systems are evident both in terms of costs and of healthy life expectancy. It was the aim of this study to assess the access points towards the different levels of care and predictors for consulting a specialist without having consulted a general practitioner (GP), a common way of access to the Austrian health care system, a system without gatekeeping function. METHOD The database used for this analysis was the Austrian Health Interview Survey 2006-07, with data from 15 474 people. Statistical analyses included descriptive statistics as well as multivariate logistic regression models. RESULTS In the 12 months before the survey, 78.8% consulted a GP, 67.4% consulted a specialist, 18.6% visited an outpatient department and 22.8% had a hospital stay at least once. Overall, 15.1% visited a specialist, 8.5% an outpatient department and 8.1% a hospital without consulting a GP concomitantly. One of the main reasons for direct specialist use was a preventive check-up visit. Tertiary education and migration background increased significantly the chance of having been to a specialist without GP contact for both sexes. CONCLUSION The overall access rates for specialists as well as the access rates for specialist without GP consultations were high. The findings point into the direction of a benefit through a structurally supported advocacy role for primary health care professionals. The knowledge gained could contribute to the health policy debate on the importance of coordination and continuity with special respect to demographic factors showing the importance of target-group-specific interventions.

Socio-economic determinants of health behaviours across age groups: results of a cross-sectional survey

SummaryBackgroundThe aim of this study was to analyse the impact of different socio-economic variables on the lifestyle factors, like lack of physical activity, diet rich in meat, and smoking, across sex and age groups in the general Austrian population to formulate more targeted public health measures.MethodsThe Austrian Health Interview Survey 2006–07 contains data of 15,474 people, representative for the general population. Statistical analyses included linear and logistic regression models.ResultsLack of physical activity was more prevalent in women, while unhealthy nutrition and daily smoking were more prevalent in men. Overall, profession was the strongest predictor for health behaviour in men, while the educational level played the most significant role in women. Subjects in higher age groups had a more healthy nutrition and were less likely to smoke, but had a higher chance for lack of physical activity.DiscussionSocio-economic factors predict lifestyle choices differently in different age groups. For example, in men, the highest percentage of daily smokers was found in the middle age, while the youngest age group was the one that smoked the most in women. Furthermore, the educational level had a reverse effect on women in the oldest age group, where those with tertiary education smoked three times more than those with less education. Our results emphasise the importance of taking a holistic approach towards health, including educational, cultural and age-specific policies to improve the overall health status and health equality of a population.ZusammenfassungHintergrundZiel dieser Studie war es, den Einfluss verschiedener sozio-ökonomischer Determinanten auf die Lebensstilfaktoren ‚fehlende körperliche Bewegung‘, ‚fleisch-reiche Ernährung‘, und ‚Rauchen‘ nach Geschlecht und in verschiedenen Altersgruppen zu analysieren, um gezieltere Public Health Maßnahmen zu formulieren.MethodenDer Austrian Health Interview Survey 2006–07 beinhaltet Daten von 15.474 Personen, und ist für die österreichische Bevölkerung repräsentativ. Statistische Auswertungen beinhalteten lineare und logistische Regressionsanalysen.ErgebnisseFrauen wiesen öfter mangelnde körperliche Bewegung auf, während bei Männern eine ungesunde Ernährung und Rauchen häufiger vorkamen. Der Beruf war der stärkte Prädiktor bei Männern, während bei Frauen die Bildung den größten Einfluss hatte. Personen in den höheren Altersgruppen hatten eine gesündere Ernährung und rauchten weniger, hatten aber auch eine größere Wahrscheinlichkeit für fehlende körperliche Bewegung.DiskussionSozio-ökonomische Determinanten haben unterschiedliche Auswirkungen auf Lebensstilfragen in unterschiedlichen Altersgruppen. Zum Beispiel fanden sich die meisten täglichen Raucher bei Männern in der mittleren Altersgruppe, während es bei den Frauen die jüngste Altersgruppe war, die am meisten rauchte. Außerdem hat Bildung einen umgekehrten Effekt bei Frauen, wo solche mit tertiärer Bildung dreimal mehr rauchten als jene mit weniger Bildung. Unsere Ergebnisse betonen, wie wichtig es ist, einen ganzheitlichen Zugang zu Gesundheit zu haben, welcher bildungspolitische, kulturelle und altersspezifische Maßnahmen umfasst, um einen einheitlichen und gerechten Gesundheitszustand in der Bevölkerung zu erreichen.

Why there is an inverse primary-care law in Africa

www.thelancet.com/lancetgh Vol 1 December 2013 e332 universal health coverage—a goodquality clinical workforce is needed that has access to diagnostic and treatment facilities, and is incentivised to work where it is most needed. In low-income and middle-income countries, this need is invariably greatest in primary care and fi rst-contact care, both because of the nature of the health services that most need to be delivered, and the importance of primary care for health-system cost-eff ectiveness. The inescapable and unrecognised implication of what our respondents said is that, in most of sub-Saharan Africa, effective primary care is not going to happen. Clinicians will not work in the conditions they experience in primary care, and these conditions are getting progressively worse as the need for effective primary care increases—thus the situation could be called the inverse primary care law. The policy discourse on universal health care in Africa now needs to focus on how to provide the necessary human resources to staff and deliver primary care eff ectively. Demand-led payment systems, such as payment by results, cannot drive up care quality unless there is a supply of well trained and well supported clinical staff to meet the demand. Innovative supply-side solutions could address poor working environments and career paths in primary care. Until these solutions are prioritised and implemented, the global poor are condemned to receive poor care or no care at all.

Antibacterial resistances in uncomplicated urinary tract infections in women: ECO·SENS II data from primary health care in Austria

BackgroundUncomplicated urinary tract infections (UTI) are a frequent reason for consultation of women in primary health care. To avoid therapy failure and development of resistances, the choice of an antibiotic should be based on the knowledge of recent local resistance data but these data are scarce for the Austrian primary health care sector. Within the context of the ECO·SENS II study it was the aim to obtain appropriate and relevant local resistance data and describe the changes in the resistance pattern in comparison to the ECO·SENS study.Methods23 GPs from different parts of Austria participated in the study between July 2007 and November 2008. According to the defined inclusion- and exclusion criteria female patients with symptoms of an uncomplicated UTI were included and a midstream urine sample was collected. In case of significant bacteriuria susceptibility testing of E. coli against 14 antibiotics was performed. Descriptive statistical methods were used.ResultsIn 313 patients included in the study, a total of 147 E. coli isolates (47%) were detected and tested. The resistance rates were in %: Mecillinam (0.0), nitrofurantoin (0.7), fosfomycin trometamol (0.7), gentamycin (1.4), cefotaxime (2.7), ceftazidime (2.7), Cephadroxil (4.1) and ciprofloxacin (4.1). Higher resistance rates were found in amoxicillin/clavulanic acid (8.9), nalidixic acid (9.6), trimethoprim/sulphamethoxazole (14.4), trimethoprim (15.8), sulphamethoxazole (21.2) and ampicillin (28.8). Additionally, the comparison of these results with the results of the ECO·SENS study demonstrated an increase in resistance rates of ampicillin, amoxicillin/clavulanic acid, nalidixic acid and ciprofloxacin.ConclusionsThe resistance data for E. coli in uncomplicated UTIs in women gained by this study are the most recent data for this disease in Austria at the moment. The increased resistance rates of amoxicillin/clavulanic acid, ciprofloxacin and nalidixic acid should be respected when choosing an appropriate antibiotic for uncomplicated UTIs. The use of ampicillin, sulphamethoxazole, trimethoprim and trimethoprim/sulphametoxazole in uncomplicated UTIs in women should be questioned at all. The findings of this study should result in a regular surveillance system of resistances emerging in the ambulatory sector designed after the model of the EARS-Net.

The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers

BACKGROUND Many low-income and middle-income countries globally are now pursuing ambitious plans for universal primary care, but are failing to deliver adequate care quality because of intractable human resource problems. AIM To understand why migrant nurses and doctors from sub-Saharan Africa did not wish to take up available posts in primary and first-contact care in their home countries. DESIGN AND SETTING Qualitative study of migrant health workers to Europe (UK, Belgium, and Austria) or southern Africa (Botswana and South Africa) from sub-Saharan Africa. METHOD Semi-structured interviews with 66 health workers (24 nurses and 42 doctors) from 18 countries between July 2011 and April 2012. Transcripts were analysed thematically using a framework approach. RESULTS The reasons given for choosing not to work in primary care were grouped into three main analytic streams: poor working environment, difficult living experiences, and poor career path. Responders described a lack of basic medicines and equipment, an unmanageable workload, and lack of professional support. Many had concerns about personal security, living conditions (such as education for children), and poor income. Primary care was seen as lower status than hospital medicine, with lack of specialist training opportunities and more exposure to corruption. CONCLUSIONS Clinicians are reluctant to work in the conditions they currently experience in primary care in sub-Saharan Africa and these conditions tend to get worse as poverty and need for primary care increases. This inverse primary care law undermines achievement of universal health coverage. Policy experience from countries outside Africa shows that it is not immutable.

African female physicians and nurses in the global Care Chain: Qualitative explorations from five destination countries

Migration of health professionals is an important policy issue for both source and destination countries around the world. The majority of migrant care workers in industrialized countries today are women. However, the dimension of mobility of highly skilled females from countries of the global south has been almost entirely neglected for many years. This paper explores the experiences of high-skilled female African migrant health-workers (MHW) utilising the framework of Global Care Chain (GCC) research. In the frame of the EU-project HURAPRIM (Human Resources for Primary Health Care in Africa), the research team conducted 88 semi-structured interviews with female and male African MHWs in five countries (Botswana, South Africa, Belgium, Austria, UK) from July 2011 until April 2012. For this paper we analysed the 34 interviews with female physicians and nurses using the qualitative framework analysis approach and the software atlas.ti. In terms of the effect of the migration on their career, almost all of the respondents experienced short-term, long-term or permanent inability to work as health-care professionals; few however also reported a positive career development post-migration. Discrimination based on a foreign nationality, race or gender was reported by many of our respondents, physicians and nurses alike, whether they worked in an African or a European country. Our study shows that in addition to the phenomenon of deskilling often reported in GCC research, many female MHW are unable to work according to their qualifications due to the fact that their diplomas are not recognized in the country of destination. Policy strategies are needed regarding integration of migrants in the labour market and working against discrimination based on race and gender.

Stressed and overworked? A cross-sectional study of the working situation of urban and rural general practitioners in Austria in the framework of the QUALICOPC project.

Aim To assess the workload of general practitioners (GPs) in Austria, with a focus on identifying the differences between GPs working in urban and rural areas. Methods Within the framework of the Quality and Costs of Primary Care in Europe (QUALICOPC) study, data were collected from a stratified sample of GPs using a standardized questionnaire between November 2011 and May 2012. Data analysis included descriptive statistics and regression analysis. Results The analysis included data from 173 GPs. GPs in rural areas reported an average of 49.3 working hours per week, plus 23.7 on-call duties per 3 months and 26.2 out-of-office care services per week. Compared to GPs working in urban areas, even in the fully adjusted regression model, rural GPs had significantly more working hours (B 7.00; P = 0.002) and on-call duties (B 18.91; P < 0.001). 65.8% of all GPs perceived their level of stress as high and 84.6% felt they were required to do unnecessary administrative work. Conclusion Our findings show a high workload among Austrian GPs, particularly those working in rural areas. Since physicians show a diminishing interest to work as GPs, there is an imperative to improve this situation.

“Why should I have come here?” - a qualitative investigation of migration reasons and experiences of health workers from sub-Saharan Africa in Austria

BackgroundThere are many health professionals from abroad working in the European Union and in Austria. The situation of sub-Saharan health workers in particular has now been studied for the first time. The objective was to explore their reasons for migration to Austria, as well as their personal experiences concerning the living and working situation in Austria.MethodsWe conducted semi-structured, qualitative interviews with African health workers. They were approached via professional networks and a snowball system. The interviews were transcribed and analysed using atlas.ti.ResultsFor most of our participants, the decision to migrate was not professional but situation dependent. Austria was not their first choice as a destination country. Several study participants left their countries to improve their overall working situation. The main motivation for migrating to Austria was partnership with an Austrian citizen. Other immigrants were refugees. Most of the immigrants found the accreditation process to work as a health professional to be difficult and hindering. This resulted in some participants not being able to work in their profession, while others were successful in their profession or in related fields. There have been experiences of discrimination, but also positive support.ConclusionsAustria is not an explicit target country for health workers from sub-Saharan Africa. Most of the study participants experienced bad work and study conditions in their home countries, but they are in Austria mostly because of personal connections. The competencies of those who are here are not fully utilised. The major reason is Austria’s current resident and work permit regulations concerning African citizens. In addition, the accreditation process and the German language appear to be barriers.

Prevalence and resistance patterns of commensal S. aureus in community-dwelling GP patients and socio-demographic associations. A cross-sectional study in the framework of the APRES-project in Austria

BackgroundThe aim of the present study was to assess the prevalence and resistance of commensal S. aureus in the nasal microbiota of community-dwelling persons in Austria, as well as to identify possible associations with socio-demographic factors. Multi-drug resistance in this population was additionally studied.MethodThis cross-sectional study was conducted within the context of the European APRES project. In nine European countries, nasal swabs were collected from 32,206 general practice patients who received care for non-infectious reasons. In Austria, 20 GPs attempted to recruit 200 consecutive patients without infectious diseases, with each patient completing demographic questionnaires as well as providing a nose swab sample. Isolation, identification, and resistance testing of S. aureus were performed. Statistical analyses included subgroup analyses and logistic regression models.Results3309 nose swabs and corresponding questionnaires from Austrian subjects were analyzed. S. aureus was identified in 16.6 % (n = 549) of nose swabs, of which 70.1 % were resistant against one or more antibiotics, mainly penicillin. S. aureus carrier status was significantly associated with male sex (OR 1.6; 1.3–2.0), younger age (OR 1.3; 1.0–1.8), living in a rural area (OR 1.4; 1.1–1.7) and working in the healthcare sector (OR 1.5; 1.0–2.1). Multi-drug resistances were identified in 13.7 % (n = 75) of the S. aureus carriers and 1.5 % (n = 8) tested positive for MRSA. The highest resistance rate was observed against penicillin (64.8 %), followed by azithromycin (13.5 %) and erythromycin with 13.3 %.ConclusionThis study describes the prevalence and resistance patterns of commensal S. aureus in community-dwelling persons in Austria and shows that differences exist between socio-demographic groups. Demographic associations have been found for S. aureus carriers but not for carriers of resistant S. aureus strains. Only two thirds of S. aureus strains were found to be resistant against small spectrum penicillin. As it is recognized that one of the corner stones for the containment of antibiotic resistance is the appropriate prescription of antibiotics in the outpatient sector, this finding lends support to the avoidance of prescription of broad-spectrum antibiotics to treat S. aureus infections in the community.