The World Health Organization’s Use of Firstline: Pushing Antimicrobial Stewardship Forward

In this article the World Health Organization’s adoption of Firstline as a platform to support antimicrobial stewardship is discussed

Interviewee: Jason Buck

Interviewer: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP

Article posted 9 August 2023

The battle against antimicrobial resistant microbes is a global one that we are all in together. Over the last few years many antimicrobial stewards from around the world have shared their perspectives and advice here on this blog, weighing in on with their experiences waging this war. This includes people from Nigeria, India, Bangladesh, Uganda, Thailand, Japan, Costa Rica, Australia, New Zealand, Canada, Spain, Turkey, and the United Kingdom. Reflecting on the naturally emerging theme of common ground, here are several quotes from the interviews…

“The best advice I can leave you with is to develop your team, make new links within and outside your organisation, be in it for the long haul, rest, and most of all, enjoy it!”
- Tariq Azamgarhi, MRPharmS, PGDip Clin Pharm, PG CEPIP, United Kingdom
‘I have learned two fundamental lessons regarding antimicrobial stewardship… First, maintain humility… Secondly, much remains to be done in this field.’
- Eduardo Clot Silla, Pharm.D., Ph.D., Spain
“One main challenge… is to increase the impact and sustainability of our interventions. This will mean embracing behavioural, implementation, and social sciences.”
- Bradley J. Langford, BScPhm, ACPR, PharmD, BCPS, Canada
“The greatest lesson I have learnt is that in order to win the fight for antimicrobial resistance there is a need to build systems for effective workflow”
- Winnie Nambatya, M.Pharm, Uganda
“There is a great opportunity for antimicrobial stewardship pharmacists across the world to learn from each other about strategies to improve antimicrobial use and how to overcome implementation barriers.”
“I think that is very important that we work together and support each other, so that we have good practices and as soon as possible we can have a standard level of work.”
- José Pablo Díaz Madriz, Pharm.D, Costa Rica
If you work hard, have patience, ambition and enthusiasm, then you can achieve your goals even if you initially know very little about what you are trying to do.
- Md Jahidul Hasan, M.Pharm., Bangladesh

As demonstrated by these comments, we all have clear and common opportunities in the area of antimicrobial stewardship. At the core of these includes teamwork, communication, and resources. This is why many governments and organizations are now putting forth initiatives to fight against antimicrobial resistance and it includes utilizing antimicrobial stewardship tools.

A very neat collaboration that has recently come to my attention is between the Canada-based technology company Firstline and the World Health Organization (WHO). One of the things they have collaborated on is the AWaRe Antibiotic book. This open-access book provides information on infectious syndromes in primary care, hospital-based infections, so-called reserve antibiotics, and antibiotic dosing guidance. If you have not yet checked it out, it’s worth at least a few minutes to familiarize yourself with this free resource. It is going to serve as a springboard to enable localized guidance on antimicrobial stewardship and it’s something to be very excited about for advancing global antimicrobial stewardship.

I was recently able to connect with Jason Buck who is the Chief Strategy Officer at Firstline. We were able to have a discussion about how Firstline is collaborating with WHO and that enabled the production of the following text which I am grateful to share here with you today…

1. How did you get involved in the field of antimicrobial stewardship?

My fascination with the intersection of technology and healthcare sparked an interest in antimicrobial stewardship.

As a technologist, I am acutely aware of the power that technology has to change the landscape of healthcare, particularly in tackling challenges like antimicrobial resistance. My journey at Firstline has led from designing and building our platform technology, through to becoming Chief Strategy Officer. I am now focused on applying our technology through initiatives with strategic partners and approaches to global health.

2. What is your role in the connection between WHO and Firstline?

Firstline’s partnership with the WHO required two main ingredients: information design for point of care guidance, and distribution of that guidance to providers’ mobile and web devices.

These play right to the core strengths of Firstline’s clinical and technical teams. But the complexities of working with the WHO as a United Nations agency, meant we also required Canadian government support, as Firstline is based out of Canada. My role was primarily steering the parties and the process to enable those Firstline core strengths to be best used.

The end result is the AWaRe Antibiotic Book, which is not only a tremendous piece of work, it provides for real and immediate action on global antimicrobial stewardship.

3. At a high-level, what is the primary goal for the WHO-Firstline collaboration?

The primary goal of the partnership is to make gold standard antibiotic knowledge accessible to every healthcare professional, anywhere in the world. By empowering all healthcare providers to make informed, evidence-based decisions on antibiotic usage, we can counter the rise of antimicrobial resistance.

By distributing the guidance electronically on Firstline, the WHO has provided the foundation on which national and local antimicrobial stewardship teams can build their own stewardship guidance. The AWaRe book is easily localized on the electronic Firstline platform to make adjustments for clinical, behavioral or cultural factors. This enables stewardship teams anywhere to quickly create and deploy locally applicable prescribing guidance.

In Italy, where we are shortly launching a national implementation, clinical leaders are utilizing our platform to calibrate the WHO’s AWaRe guidance to the local specificities of Italian outpatient and pediatric prescribing. This is a great case-study for the benefits of building on top of global-strength clinical guidance, being able to make essential local adaptations, and rapidly delivering actionable guidance to the point of care.

The significance of this partnership is immense – far beyond distributing a single version of guidance. It is about creating a sophisticated practice tool that is always up to date, easily deployable anywhere, and enthusiastically adopted by clinicians everywhere.

4. In what way is Firstline able to help make critical resources available at the point of care?

Firstline delivers actionable guidance right to the point of care through mobile and the web. We know that healthcare professionals are often short of time and need to make quick decisions. Therefore, the challenge is not just about making resources available; it is about crafting those resources so they become super easy for busy individuals to follow in real-time clinical decision-making.

That means no pinching and zooming of PDFs that were originally designed for use on a desktop, for example. Firstline’s meticulous information design, combined with an intuitive user experience, really sets it far apart.

The clarity and ease of use fosters better concordance with guidance, encouraging behavioral change in prescribing practices, and consequently promotes optimal antibiotic use. Our goal is to bridge the gap between guidance and practice, turning optimal antibiotic use from an aspiration to an everyday reality.

5. Implementation science has been a hot topic in antimicrobial stewardship, how is the WHO-Firstline collaboration helping with this?

The issue of implementation gaps in healthcare is neither new nor unique to our fight against antimicrobial resistance. Almost two decades ago, researchers called for “more effective ways of promoting the uptake of evidence-based interventions,” a need that still resonates today across all facets of healthcare. However, this is particularly acute in the context of drug resistance, where poor practices in any part of the globe can cause problems everywhere.

The first challenge in any implementation is always access, and distribution of the WHO AWaRe guidance is pioneering in several ways. It is the first time ever that the WHO has produced guidance on the use of antibiotics in the treatment of the most common infections – not just drug information. Moreover, access to evidence-based guidance is a challenge in many parts of the world. The availability of Firstline on low-powered Android devices, and low-data connections or even offline, is a vital innovation.

Secondly, adoption and implementation are tremendously significant challenges for stewardship programmes. The ability of any organization to use Firstline to easily and quickly adopt and adapt the WHO AWaRe guidance according to local factors is an important innovation. It frees organizations to devote increased focus to applying locally appropriate behavioral cues that encourage appropriate prescribing, and to building an engaged movement of providers behind the stewardship initiative.

This is an aspect of stewardship programmes we have developed a wealth of experience in, and are now using a Firstline implementation framework to support stewardship teams.

The less antimicrobial stewardship programs need to reinvent the wheel on evidence-based guidelines, the more they can focus on the most significant challenges – adoption and engagement.

6. Who can use the Firstline resources from the WHO collaboration?

The AWaRe guidance on Firstline is available free to all, in every country.

It is a global tool designed for use everywhere – including high-income countries with the most sophisticated healthcare systems. If prescribers do not have localized stewardship guidance available, they should use the WHO’s AWaRe guidance.

7. The relationship between WHO and Firstline is just budding today, what are you excited about that the future may hold?

What excites us most is the potential for the Firstline platform to serve as a conduit for the fast and free flow of antimicrobial stewardship resources worldwide.

It currently enables national and local healthcare organizations to lean on the evidence-based guidance of the world’s apex healthcare organization. This prospect – combining authoritative global guidance with local relevance and specificity – is one we find particularly promising for future stewardship efforts.

By combining WHO’s gold standard guidance with Firstline’s capability to localize and distribute guidance into the hands of clinicians, we have been able to create a hugely positive initial impact, and we are excited to see this impact increase as it becomes more globally adopted.

About the Interviewee

Jason Buck – Chief Strategy Officer

Jason leads Firstline’s product development team and leans on over 20 years of commercial experience to coordinate Firstline’s non-organic growth including through intellectual property and partnerships with government and international organizations.

Prior to Firstline, Jason led an e-commerce venture for 15 years, creating and evolving partnerships with some of the most respected corporations in the UK.

Disclosure: The views and opinions in this article are that of the author and do not necessarily reflect the opinion or policy of any former, current, or potential future employer.

Interviewer’s note: I would like to express my utmost gratitude to Jason for taking the time out of his busy schedule to complete this article and to also thank him for his contributions to the field, as the world needs people like him to advance antimicrobial stewardship!

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