The EVIPNet webinar series offer a platform for network members to exchange on best practices, lessons learned, and latest innovation in evidence-informed decision-making and knowledge translation for health policy and practice.
Three questions to presenters Maja Subelj and Polonca Truden-Dobrin, National Institute of Public Health, Slovenia
How did you identify the challenge of antimicrobial resistance (AMR) as a priority health policy issue in Slovene long-term care facilities (LTCF)?
As in many European countries, the aging population combined with the increasing number of antibiotic-resistant pathogens and related treatment complications pose a major public health challenge in Slovenia. There are many large retirement homes and long-term care facilities in the country, and infection prevention and control measures are tricky to implement given the frequent contacts of residents. In addition, most retirement homes do not systematically use microbiology tests to determine effective antibiotic treatments and are missing reliable antibiotic stewardship mechanisms. This means broad spectrum antibiotics are used without clear indication and without testing, bearing both health risks for residents and contributing to increased antimicrobial resistance.
How did you develop your evidence brief for policy (EBP) and prepare for the policy dialogue?
We started by setting-up a multidisciplinary working group with several infectious disease and public health specialists. With hands-on technical support from the EVIPNet team at the WHO Regional Office of Europe and the help of the WHO Country Office in Slovenia, we then embarked on producing a comprehensive evidence brief for policy. We conducted a systematic literature review on antimicrobial resistance in long-term care facilities with a particular focus on recent and locally applicable evidence and aspects of equity in care. The review then led us to identify three implementation options as part of a more comprehensive antimicrobial stewardship approach: better surveillance and monitoring of antibiotic use and resistance patterns, the development and implementation of diagnostics and treatment guidelines, and improving information for residents and their families. In November 2018, we presented and discussed the evidence brief at a multisectoral policy dialogue with all key stakeholders, including primary care and nursing providers, public health specialists, and representatives of retirement homes, health insurances, and the social sector.
What key lessons from tackling antimicrobial resistance in long-term care facilities would you highlight for other EVIPNet members and country teams?
The policy dialogue made clear that intersectoral cooperation will play a key role in tackling the issue, both at the national level and between local health and social services. The early involvement and broad consensus we had established among the participants now proved crucial and catalyzed a series of follow-up activities, while the Ministry of Health’s support put policy options on the political agenda. We continued facilitating communication among working group experts, the Ministry of Health, the National Health Insurance Fund, and long-term care facilities. We also organized a national meeting with care facilities’ staff to discuss implementation in 2019, and supported workshops led by clinical pharmacists for medical doctors. Despite these positive outcomes, the limited capacity and missing resources within the Ministry of Health and the National Institute of Public Health slowed the systematic implementation of antimicrobial stewardship. The evidence-informed policy process established with the EBP finally also proved useful in planning infection prevention and control measures in long-term care facilities during the COVID-19 pandemic. Much remains to be done, however, to establish a sustainable knowledge translation platform for the systematic and transparent use of research evidence in health policy making in Slovenia.