title: Patient engagement with infection management in secondary care: a qualitative investigation of current experiences.
abstract: To understand patient engagement with decision-making for infection management in secondary care and the consequences associated with current practices.
  
  
  
  A qualitative investigation using in-depth focus groups.
  
  
  
  Fourteen members of the public who had received antimicrobials from secondary care in the preceding 12 months in the UK were identified for recruitment. Ten agreed to participate. All participants had experience of infection management in secondary care pathways across a variety of South-East England healthcare institutes. Study findings were subsequently tested through follow-up focus groups with 20 newly recruited citizens.
  
  
  
  Participants reported feelings of disempowerment during episodes of infection in secondary care. Information is communicated in a unilateral manner with individuals 'told' that they have an infection and will receive an antimicrobial (often unnamed), leading to loss of ownership, frustration, anxiety and ultimately distancing them from engaging with decision-making. This poor communication drives individuals to seek information from alternative sources, including online, which is associated with concerns over reliability and individualisation. Failures in communication and information provision by clinicians in secondary care influence individuals' future ideas about infections and their management. This alters their future actions towards antimicrobials and can drive prescription non-adherence and loss to follow-up.
  
  
  
  Current infection management and antimicrobial prescribing practices in secondary care fail to engage patients with the decision-making process. Secondary care physicians must not view infection management episodes as discrete events, but as cumulative experiences which have the potential to shape future patient behaviour and understanding of antimicrobial use.
authors: National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London UK.|Imperial College Healthcare NHS Trust, London, UK.
authors: Timothy M
authors: TM
authors: Rawson
authors: National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London UK.|Imperial College Healthcare NHS Trust, London, UK.
authors: Luke S P
authors: LS
authors: Moore
authors: Centre for Bio-Inspired Technology, Imperial College London, London, UK.
authors: Bernard
authors: B
authors: Hernandez
authors: National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London UK.
authors: Enrique
authors: E
authors: Castro-Sanchez
authors: National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London UK.
authors: Esmita
authors: E
authors: Charani
authors: Centre for Bio-Inspired Technology, Imperial College London, London, UK.
authors: Pantelis
authors: P
authors: Georgiou
authors: National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London UK.
authors: Raheelah
authors: R
authors: Ahmad
authors: National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London UK.|Imperial College Healthcare NHS Trust, London, UK.
authors: Alison H
authors: AH
authors: Holmes
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D003142:Communication; D003657:Decision Making; D004352:Drug Resistance, Microbial; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D010358:Patient Participation / Q000706:statistics & numerical data*; D036301:Qualitative Research; D015203:Reproducibility of Results; D063127:Secondary Health Care; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: INFECTIOUS DISEASES; antimicrobials; shared decision making