Promoting evidence-informed policy development to combat antimicrobial resistance in Slovenia

A newly published Evidence-informed Policy Network (EVIPNet) Europe evidence brief is assisting Slovenia in tackling the problem of prescribing broad-spectrum antibiotics to older people in long-term care facilities. EVIPNet Europe evidence briefs are user-friendly syntheses of the best available evidence from global and local research that address a specific policy problem in a concise way.

Use of broad-spectrum antibiotics in Slovenian long-term care facilities

Although antibiotic consumption in Slovenian long-term care facilities is low compared to other countries in the WHO European Region, analysis suggested that these medicines are frequently prescribed inappropriately. This means older residents receive antibiotics without proper diagnosis of infection and microbiological testing, and/or an unsuitable choice, dose or duration of therapy.

The inappropriate prescription of antibiotics can have severe consequences for morbidity and mortality among residents of long-term care facilities. Antibiotics can interact unfavourably with drugs taken to manage other conditions, and older patients are also at higher risk of adverse drug reactions. Importantly, it also leads to the development of antimicrobial resistance (AMR) among the bacteria colonizing the body.

Long-term care facilities are sites where AMR pathogens spread easily because residents live in an enclosed environment with limited mobility; have repeated interactions with other residents, staff and visitors; and often have frequent contact with hospital environments.

The inappropriate prescription of antibiotics in long-term care facilities also contributes to the wider spread of AMR in Slovenia, resulting in deteriorating health outcomes and increasing health-care costs.

Concrete options to combat AMR

Dr Darina Sedláková, Head of the WHO Country Office in Slovenia, explains that the main purpose of the evidence brief was “to develop evidence-informed options for the country to consider in tackling the problem”.

The publication is based on a synthesis of the relevant global and local scientific evidence, including systematic reviews of the literature where possible. It outlines 3 policy options to combat AMR in Slovenian long-term care facilities:

1. the surveillance, monitoring and audit/feedback of antibiotic consumption and AMR in long-term care facilities;
2. the development and implementation of guidelines and clinical pathways for diagnosing and treating infections; and
3. continuous medical education for health-care professionals and the provision of health information to residents of long-term care facilities and their relatives/visitors.

Countries in the Region can consider these options as a starting point for tackling AMR in long-term care facilities, and adapt them to their particular health- and social-care contexts.

Evidence brief informs policy dialogue

The evidence brief for policy formed the basis of a policy dialogue on AMR in Slovenia on 14 November 2018. Policy dialogues are events that gather and engage all those who will be involved in, or affected by, future decisions about the issue in question. They facilitate the development of new understanding and new approaches through collaborative work, and aim to stimulate action among participants as well as those who review the dialogue summary.

The Ministry of Health of Slovenia commissioned this evidence brief for policy, which was developed by the Slovenian EVIPNet Europe country team with the support of the EVIPNet Secretariat (hosted in the Division of Information, Evidence, Research and Innovation at WHO/Europe) and the WHO/Europe control of AMR programme (Division of Health Emergencies and Communicable Diseases) in close collaboration with the WHO Country Office in Slovenia.

Dr Polonca Truden, Senior Specialist in Public Health Medicine at the Slovenian National Institute of Public Health, said, “As we come to the next phase of evidence-informed policy-making at the policy dialogue, I look at the work we have been through and I cherish the support we have been given by the EVIPNet Secretariat and EVIPNet members. The EVIPNet tools really helped our group in developing the evidence brief for policy and the feedback the Secretariat provided was invaluable.”

About EVIPNet Europe

Launched in the WHO European Region in October 2012, EVIPNet Europe is a regional WHO initiative that promotes the systematic and transparent use of evidence from health research in policy-making. EVIPNet Europe, operating under the aegis of the WHO European Health Information Initiative, is hosted by the Knowledge Management, Evidence and Research for Policy-Making Unit in the Division of Information, Evidence, Research and Innovation at WHO/Europe.