Paradigm Shift in Treatment for ABSSSI

Segment Description: Yoav Golan, MD, attending physician at Tufts Medical Center and associate professor at Tufts University School of Medicine, discusses the paradigm shift occurring in treatment for ABSSSI and how to motivate clinicians to buy into new programs and protocols.

Interview transcript (modified slightly for readability):

Yoav Golan, MD: “I think that with increasing incidence, occurrence of skin infections and the following increase in admissions, and the fact that when you actually look into those admissions you find that many of the patients that get admitted with skin infections don’t get admitted because of a concern that requires close monitoring, as would be provided in a hospital, but get admitted for intravenous therapy that could only be given in admission. I think that this creates an opportunity because if you could infuse them with the antibiotics that they need during the admission—before they get admitted—then you took the 1 reason for them to get admitted [away]. You would save a lot of money, you would make it a lot safer for them not to be in a hospital where they don’t need to be and improve their quality of life tremendously; it really is a win-win type of situation.

The challenge with that is that it’s a new paradigm and [with] new paradigms, you need to change the way people think; you need to create systems that allow this to be feasible. And so, we are in a transition period. I think in maybe 5 or 10 years we’re going to look backwards at the way we used to admit those patients, or even see them in the emergency department, thinking that this is an admission type of diagnosis, that we’ve been out of our minds, and [about] all the money that we invested.

Now, we are learning how to use those new treatment options and make them possible. I think the main challenge is really education. I think that people first have to understand that such options exist for them to ask the question ‘So, how do we do it now?’

But we’re at this stage and I would say it’s very exciting because for many years from a paradigm shift perspective, we didn’t really have anything new that we could offer, and now we do.

How do you get people to buy into protocols and programs that you put together? I think by that you touch a much bigger point which is the standardizing of antibiotic management in hospitals.

It used to be that every surgeon and every orthopedic surgeon and any dermatologist and any internist could choose whatever they wanted and treat their patients and usually it would be successful because resistance was not very prevalent.

Nowadays, we are in an era in which there’s a lot of resistance even interpreting culture results coming from the micro-lab can be challenging for many clinicians and many clinicians are not able to interpret culture results within the context of the patient and the best management for the patient. And so, we are moving into more and more guidance provided to clinicians—young clinicians accept that because they were born into that in their professional life, older clinicians are harder to get into it because you take their freedom to choose. But, I think that if you think about that you don’t really take their freedom to choose you actually allow them or you help them choose the right things.

I think that any program could be constructed in many different ways and I think that if you construct the program in a way that really works for the different stakeholders and allow them to actually input and maybe own the program or own part of the program and help you design the program, help themselves design the program, the way they will find the program the most useful, I think the program will help. I think that at the end of the day, the main motivation should be patient benefit and I think if you can clearly show care providers that whatever you’re going to help them do is going to improve their patient care, I think they’re all for it, because that’s what they do.

I think we are in a transition period from that perspective as well, from no guidance to almost enforcing our ideas on others but this enforcement can be, for a program that they own, and therefore, feel comfortable [about] because they had an input into the program.”