A Annual Report of the Chief Medical Officer (2011)highlighted the urgent need of the strategic management of AMR in England,suggesting the scale of threat of antimicrobial resistance been seen from theHealthcare Associated Infection and antimicrobial usage in England PointPrevalence Survey (2014), and the need for action. In response to this,Department of Health set out UK 5 Year AMR Strategy 2013 to 2018 (2013) and PHEtook in charge of the role of providing surveillance data, and has workedclosely with National Health Service on implementation of antimicrobialstewardship programme and facilitation of professional education and publicengagement.
The most recent English Surveillance Programme for AntimicrobialUtilisation and Resistance (ESPAUR) (2017) highlighted that the development ofNHS antimicrobial stewardship initiatives, namely Quality Premium (QP) andCommissioning for Quality and Innovation (CQUIN) showed the most significantresults. The report stated that both has quantified their achievement and madeit clear that action was needed across every Trust. Even similar action hasalso been carried out in China, such as Administrative Regulations for ClinicalUse of Antibiotics (2012) and National guidelines for antimicrobial therapy (2013),but a number of studies including the one by Li W et al. (2016) was highlycritical of the strategic management of AMR in China. Suggesting thatregulation policy and following actions was not solving the most problematicarea which is the rural area. The report criticised the lack of input and theidentified major challenges are the lack of qualified healthcare professionalsand poor access of information.
More broadly, official guideline specificallyfor tackling antimicrobial resistance has only recently been developed in 2016,and thus evidence-based use has not yet been widely investigated, so thebenefits and outcomes of the initiatives are still hard to tell andquestionable.Consumption of Antibiotic without change of infection episodehave declined over this period, but limited research been done, it is hard toshow and conclude its effectiveness in China. But what I realised from chattingwith the staff in elective placement hospital is that UK and China will becollaborated to tackle the antimicrobial resistance problem especially in ruralChina region. What I do know now is that large-scale, interdisciplinary, UK-China collaborative research would be done in humans, animals and the widerenvironment in China (Research Council UK, n.d.). The first confirmedcollaboration would be done in Anhui with University of Bristol, investigatingon localised strategies to optimise AMR regulation (2016).
All the project willbe started in early 2019 so it is still impossible to attribute success to anyone collaboration, nor it is possible to tell which components of thecollaboration would benefit the most. But what I do know is the multimodal,region-adapted research and interventions can show us where the problem is. Ialso know that having the backing of a national guidance and global surveillancegains the attention of government executives, bringing focus and resource toAMR where needed and providing strong reinforcement. But much learning aboutwhat works in China has been limited because so little research and evaluationwas conducted to determine effectiveness or to identify mechanisms of changeand contextual influences. A key thought upon reflection is that future AMRregulations in China or even global context would benefit from a programme ofhigh quality evaluation research running in parallel to help understand whatworks and why. Most importantly, as a future physiotherapist, ensuring ownresponsibility to infection control to prevent infection from occurring in thefirst place should be one of the best way for me to reduce the need toprescribe antibiotics and prevent antimicrobial resistance. Therefore in thefuture practice, infection prevention and control would become even moreimportant and I should regularly reflect my practice to ensure an optimal contributionin infection control.
Learning Outcome: Evaluate the health care needs of the population served by the electiveplacement and demonstrate cultural competence with adaptation of practiceappropriate to the placement.Althoughpatients were targeted to have their own individual treatment plans tailoredwith their own needs throughout my placement, I noticed that patients tend totake an uninvolved role in clinical decision making process and there weredisproportionate amount of passive treatment implementation comparing to myplacement experience in UK. As the placement progressed I noted that Chinesemanual therapy, acupuncture, electrotherapy and traction therapy formed a largeproportion of the treatments (See Appendix E). A number of studies includingone by Rongchong et al. (2015) have found that Chinese patients are more likelyto take an uncomplaining role on clinical decision-making process and morelikely to prefer inactive treatment like manual therapy and acupuncture.
Additionally this is not only limited to geographic location, a number ofstudies also found out that multiracial Chinese in other countries are having ahigher tendency of taking uninvolved role among other ethnicity (Leung YM etal., 2014; Kwok C & Koo FK, 2017). At the start of the placement, having no experience ofworking with this service user group I felt slightly challenging and limitedwith their passive approach