Pharmacy Check-in: Meet Bradley Langford
Bradley J. Langford, BScPhm, ACPR, PharmD (he/him)
Pharmacist Specialist, Antimicrobial Resistance and Stewardship
Public Health Ontario
Bradley Langford is a Pharmacist Specialist with the Antimicrobial Resistance (AMR) and Stewardship Team at Public Health Ontario (PHO). This team aims to mitigate the growing public health threat of AMR across all health-care settings in the province. They are responsible for providing leadership on antimicrobial stewardship best practices, conducting research and surveillance of antimicrobial use and resistance provincially, and developing resources and tools to support antimicrobial stewardship across practice settings.
Bradley also works part time at Hotel Dieu Shaver Health and Rehabilitation Centre in St. Catharines, Ontario, where he helps support the hospital’s antimicrobial stewardship program through the development, implementation and evaluation of guidelines and standards for antimicrobial prescribing, and education of staff and patients on the optimal use of antibiotics to improve their efficacy and safety.
Q&A with Bradley
In advance of World Antimicrobial Awareness Week, we caught up with Bradley to talk about AMR and how how we can all help fight this growing global issue.
What is antimicrobial resistance (AMR) and why is it such a critical issue?
There is no question that antibiotics and other antimicrobials are essential components of a functioning health-care system. Without effective antibiotics, there is increased risk of death and costs to the health-care system and society. But overuse can have devastating effects and lead to antimicrobial resistance (AMR), which occurs when microbes, such as bacteria, develop ways to resist the effects of antimicrobial drugs, making infections more difficult to treat and prevent. In fact, a recent Canadian report indicates that AMR costs about 15 Canadian lives per day and $2 billion in GDP per year. These numbers are expected to increase drastically if we do not act sufficiently to mitigate this threat. Antimicrobial use is the main driver of AMR, and up to half of prescriptions are unnecessary, so finding ways that we can use antimicrobials more judiciously—a concept called antimicrobial stewardship—can help to prevent worsening AMR. According to the recent Pan-Canadian Action Plan on AMR, antimicrobial stewardship is one of the main pillars of action needed to address AMR. This national plan indicates that pharmacists are important team members in stopping AMR.
Why did you choose to become an antimicrobial resistance and stewardship specialist?
While one-on-one patient interactions are rewarding, I have always been interested in population-level interventions—strategies to benefit more than one patient at a time. I’ve worked in hospital for over 10 years implementing strategies to improve antimicrobial stewardship, such as prospective audit and feedback, antimicrobial use and resistance tracking and reporting, and developing policies and procedures to support more rational antibiotic prescribing. Following my interest to support antimicrobial stewardship at a population level, I took on my current position at PHO where we aim to improve antimicrobial stewardship for a much larger population of over 14 million Ontarians.
What makes pharmacists ideal partners in combatting AMR?
As medication experts, pharmacists are crucial team members in improving the quality and safety of antibiotic use. Pharmacists are also one of the most accessible and trusted health-care professionals, making them a first point of contact for many patients when an infection is suspected. And they are already key partners in combatting AMR through their involvement in immunization programs (reduces risk of infections that can lead to drug resistance) and minor ailments prescribing (to prescribe antimicrobials according to best-practice guidelines).
What role can pharmacists play in educating patients about the dangers of AMR?
While antimicrobials save millions of lives by treating and preventing infections, health-care professionals and patients tend to overestimate their benefits and underestimate their risks, so they are often used “just-in-case” or in situations in which they provide no benefit (such as infections typically caused by viruses like bronchitis and the common cold). Pharmacists play an important role in re-calibrating this risk vs. benefit assessment of antibiotic use. Recent public opinion research by the Public Health Agency of Canada found that 28% of patients believe that antibiotics are effective for cold and flu. Pharmacists can help patients understand both the lack of benefit, but also the risks of an unnecessary prescription, including side effects, C. difficile infection and antimicrobial resistance, which can make future infections more difficult to treat.
Do you have any practical tips on how pharmacy teams can implement antimicrobial stewardship programs or processes in their pharmacies to help combat AMR?
There is a growing number of strategies that can be used in the community to support antimicrobial stewardship. The Public Health Ontario website highlights 7 evidence-based strategies for antimicrobial stewardship in primary care. Specific ways that pharmacists can help include engaging patients in shared decision making to better understand both the benefits and risks of antibiotics, encouraging other prescribers to include a reason for use on the antimicrobial prescription, and educating prescribers on antimicrobial stewardship principles and tools. Our research has also found that prescribers are particularly amenable to suggestions from pharmacists to shorten inappropriately long durations of antibiotic therapy. Shorter, evidence-based courses are associated with a lower risk of side effects and antimicrobial resistance. There is still a lot to learn about how pharmacists can help advance antimicrobial stewardship. We are keen to learn about these opportunities and hear success stories from other pharmacists.
What makes you proud to be a pharmacist?
Pharmacists are playing an increasingly important role in the health-care system and our expertise is increasingly being recognized in community, hospital, government and industry. I am particularly proud of the emerging role of pharmacists in public health. I think this role will only grow as we plan to prevent and respond to future pandemics.