Health equity has been defined by CDC as the state in which everyone has a fair and just opportunity to attain their highest level of health. It is becoming an increasingly important conversation within healthcare, extending its influence into specialized fields such as antimicrobial stewardship. Firstline recently attended a SHEA/CDC workshop on the topic in Atlanta and left with three key takeaways:

1. The call for more equity data and research

At the workshop, Dr. Lauri Hicks, the director for the Office of Antibiotic Stewardship at CDC, presented a recently published systematic scoping review on health equity . She shared that of the thousands of studies they looked at, the majority did not have health equity as a pre-specified objective. In fact, only 61 of the studies met the inclusion criteria for equity and stewardship. She also revealed that only one study focused on the acute care setting, where health disparities and bias in medicine can be tightly linked to patient outcomes. This was a disappointing reality, given the disproportionate effect that infectious diseases have on minoritized communities.
Dr. Hicks’ presentation struck as a call to action, emphasizing the need for future stewardship research that collects and shares data on relevant markers of healthcare equity and antimicrobial stewardship prescribing - an overarching theme that resonated through the entire workshop. But how can we effectively prompt healthcare providers to overcome the discomfort of unconscious bias or learned assumptions, beliefs or attitudes, and truthfully “check their biases” as a healthcare provider? Additional focused research is required to identify and propel actions that will mitigate biased health and healthcare outcomes.

2. Gender inequities among healthcare providers

During a panel discussion, Chris Evans (Tennessee Department of Health) emphasized a need to address issues of equity among healthcare providers - not just between providers and patients. He referenced a paper by Valerie Vaughn et al that highlighted female stewards were less likely to make stewardship recommendations to providers, and when they did, they were far less likely to be accepted as compared to their male steward counterparts. This dismissal of recommendations due to gender inequity has cascading effects on patient care, ultimately affecting how well a stewardship program works. Increasing awareness about this issue and establishing measures to mitigate gender bias is essential for building quality stewardship programs that are effective and equitable. Sharing the statistics and implementing clear policies that are easy to universally adopt and reference definitely helps - an undertaking that is supported and facilitated by Firstline today.

3. Stewardship and The Joint Commission equity standards

The Joint Commission’s updated standards now mandate a role for equity in healthcare organizations. The workshop encouraged everyone to reach out to, and collaborate with, those leaders in charge of equity at their organization. In terms of achieving health equity in antimicrobial prescribing, Dr. Lauri Hicks shared that it has been confirmed with The Joint Commission that recommended stewardship activities to meet the needs of the new standards.

Efficiency and effectiveness in the pursuit of health equity

The SHEA/CDC workshop was an important event to drive home the reality of what still needs to be done to achieve health equity. The resounding conclusion is not a surprise - what we are doing today is not enough. Our mindsets play a pivotal role in reducing disparities in health care. Through focused research and analysis of antimicrobial stewardship practices, raised awareness of our unchecked biases and standardized policies and processes from The Joint Commission, we can commit to building a safer healthcare setting for both patients and providers that will result in equal treatment and a higher quality of care for everyone.

Do you have thoughts or a story to share? Firstline would like to hear from you about your experiences and ideas for creating health equity in antimicrobial prescribing.