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Estonian primary health care: How to combat antimicrobial resistance

The European Union/European Economic Area has more than 670 000 drug resistant bacterial infections each year. There are also approximately 33 000 people who die as a result of these infections.

Data show that Estonia has a low level of antibiotic use and AMR, but the country’s broad-spectrum antibiotic consumption is rising. About 87% of Estonia’s total consumption of antibiotics in 2019 was in the primary-care sector, indicating that prescribing patterns need to change to address this problem.

Policy based on evidence and research

In Estonia, WHO’s Evidence-informed Policy Network (EVIPNet) supports the systematic use of health research evidence in policy-making as well as country-level partnerships among policy-makers, researchers and civil society. EVIPNet facilitates both the development and implementation of policy through the use the best scientific evidence.

The second evidence brief on policy in Estonia produced within the framework EVIPNet focuses specifically on AMR. It was prepared jointly by the Institute of Family Medicine and Public Health of the University of Tartu and the Ministry of Social Affairs of Estonia and WHO Country Office.

The evidence brief highlights 3 key policy options to increase the use and prescriptions of broad-spectrum antibiotics in primary care.

  • Enhancing postgraduate education and continuing education of primary-care clinicians regarding the proper use of antibiotics. This can be done through educational materials and formal continued medical education activities. Outreach visits, small discussion groups, or online courses are all ways to do this.
  • A system or tool to support primary-care physicians in the prudent use and management of antibiotics. It integrates clinical, patient and reference information to help evidence-based decision-making in patient care.
  • To improve prescribing behaviour, use feedback and audits.

Overall, evidence suggests that the three policy options complement one another and that combining them might be the best course of action.

One Health action plan

The evidence brief describes the options that are available to primary-care patients. However, awareness-raising and education programmes aimed at patients will help decrease the demand for antibiotics. Any of these options will require the development national guidelines for the prescription and use antibiotics.

Estonia must also accelerate the development of its national AMR action plan for human and environment health and finalize the national One Health action plan. A close collaboration between the human and animal health (wild and domestic) and the environment sector is essential for effective prevention and control and combating AMR. AMR must be prioritized and recognized in order to ensure that resources are allocated for appropriate prescribing.

Participants engaged in a policy dialog to discuss the current situation, and to agree on next steps.

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