[Table of Contents]

Volume: 23S7 - November 1997

CONTROLLING ANTIMICROBIAL RESISTANCE
An Integrated Action Plan for Canadians

CONFERENCE OBJECTIVES AND RECOMMENDATIONS

WORKING GROUP ISSUES

4. Communicating and Evaluating the Action Plan

Two working groups were responsible for making recommendations on 1) communicating the decisions of the conference to health care professionals, funding agencies, governments, the media and the public, and 2) ensuring, after the conference is over, that the action plan developed is discussed, adapted and implemented.

It was recognized that communication of knowledge and information about antimicrobial resistance, though important, is not enough to guarantee changes in behaviour on the part of physicians, the public and health care providers involved in infection control. The perspective should be one of finding out what these people need to know, and making them a part of any process that is geared to change.

According to the model of Prochaska and Diclemente⁽²²⁾, the kinds of interventions needed to change behaviour in an individual will depend upon the stage that person has reached in the cycle of precontemplation (before the idea of change is even present), contemplation (considering change), preparation, active change and maintenance of change. One example would be the relatively low rate of use of clinical practice guidelines among physicians (14% of physicians referred to them once weekly) that was found in a Canadian Medical Association survey in 1994⁽²³⁾. It may be that physicians need more in the way of enabling factors - those that facilitate change - such as positive models among their colleagues or practical ways to remember individual guidelines, before they move from the contemplation stage to that of active change.

It was also felt that the strategies used to communicate details of the action plan to the various stakeholders and to gain their involvement would depend upon the individual recommendations themselves, but that in general such strategies would address the way in which the message will be put across, to whom and by whom. Any of these issues may change over time, according to feedback derived as the process unfolds. Certain behaviours may need to be promoted that are not in themselves attractive or interesting, and in this case the communications strategy will have to be particularly compelling. There will be a need to involve professional communicators. The idea that certain goals identified during the conference may be worth pursuing first, either because there is scientific evidence to back them up or because they are seen by a majority of interested parties as highly important, was also accepted.

There were several suggestions for maintaining the momentum of the discussions and decisions taken at the conference:

• involve the media, both now - with details of the conference - and on an ongoing basis - by providing short, timely stories;
• identify the key persons or organizations for each recommendation to make sure that there is continuity after the conference is over;
• ensure that the highlights of the conference are distributed within 10 days, and that a summary report is published within 2 months.

With regard to achieving implementation of the action plan, an organizing body was felt to be essential to take overall responsibility for directing action on each recommendation. This body would facilitate adoption or local adaptation of the recommendations by existing bodies; ensure continuous monitoring of each recommendation's implementation; use existing evaluation strategies or develop new, appropriate indicators to assess outcomes for each recommendation; organize the collection of data on which further recommendations might be based; provide a clearinghouse of key information on antimicrobial resistance; and make sure that the information is available to all stakeholders.

The members of the organizing body will represent a number of specialties and interests: infectious diseases, infection control, laboratory microbiology, physicians (general practitioners and specialists), nurses, epidemiologists, consumers, public health personnel, hospitals, educational institutions, veterinary personnel, agri/aquaculture representatives, pharmacists, members of the pharmaceutical industry, health economists and specialists in ethics, social sciences and communications.

Recommendation 19

To convene a Canadian Coordinating Committee on Antimicrobial Resistance (CCCAR) within 6 months of this conference. This committee, with a broad representation of stakeholders, will meet twice a year and will take leadership and responsibility for ensuring effective implementation of recommendations by the stakeholder groups.

Recommendation 20

To provide CCCAR with a full-time secretariat (financed chair).

Recommendation 21

To subject each recommendation of this consensus conference to periodic review and evaluation to examine:

i. the stage of implementation and its effectiveness in mobilizing leadership mechanisms to address antimicrobial resistance issues;

ii. its effectiveness in terms of measurable outcome goal achievements.

Recommendation 22

To develop a strategy to ensure that adequate resources are allocated for the implementation of the overall recommendations.

Recommendation 23

To explore regional funding mechanisms to ensure the availability of needed experts (infection control, infectious diseases, medical microbiologists) now and in the future.

Recommendation 24

To incorporate consumers (targets) and local issues in the development of communications plans for each recommendation. These plans will include needs assessment and identified barriers. Consumers may help to identify positive factors.

Recommendation 25

To develop a communication strategy for each recommendation:

• Who will organize?
• Who are the targets? What resources are necessary (existing vs. new)?
• What communications modality will be used?
• What are the time lines?
• How will the effect of the communication strategy be evaluated?

Recommendation 26

To prioritize each recommendation based on the underlying evidence and importance to antimicrobial resistance and usage.

Recommendation 27

To use a communications package that will promote behaviour change in usable, practical, attractive, achievable steps. Ongoing evaluation of the communications strategy will permit modification and improvement.

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