scholarly journals Physician experiences implementing antimicrobial stewardship rounds in pediatric hospital medicine: An exploratory, qualitative study

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Megan L. McCreary ◽  
Alena Tse-Chang ◽  
Karen L. Forbes ◽  
Jessica L. Foulds
Keyword(s):  
Qualitative Study ◽  
Clinical Reasoning ◽  
Antimicrobial Stewardship ◽  
Hospital Medicine ◽  
Professional Relationships ◽  
Semistructured Interview ◽  
Face To Face ◽  
Individual Interviews ◽  
Education And Development ◽  
Constant Comparative Analysis

Abstract Objectives: An antimicrobial stewardship intervention was implemented for pediatric medicine units using an in-person rounds-based approach to provide stewardship recommendations and education from an antimicrobial stewardship physician and antimicrobial stewardship pharmacist. Design, Setting, Participants, and Methods: In this exploratory qualitative study, purposeful sampling was used to recruit participants for individual interviews at a tertiary- and quaternary-care referral center. Pediatricians and residents who attended ≥1 stewardship round were included. A semistructured interview guide was created focusing on perceptions of antimicrobial stewardship, personal experiences at stewardship rounds, and perceived impacts on patient care. Using a constant comparative analysis approach, codes were developed and collapsed into themes. Results: Overall, 8 pediatricians and 10 residents completed interviews. Qualitative analysis yielded 3 themes: insights into clinical reasoning, opportunity for growth and learning, and establishing and exploring professional relationships. The handshake-rounds approach encouraged participants to critically evaluate antimicrobial choices and to engage in discussion with the antimicrobial stewardship team. Participants felt validated at stewardship rounds and gained confidence prescribing antimicrobials. Face-to-face interaction reduced reluctance for some participants to consult infectious disease (ID) service; however, others worried that physicians may avoid ID consultation because of stewardship rounds. Conclusions: Participants found stewardship rounds to be an effective strategy for education and development of clinical reasoning skills for optimal antimicrobial prescribing—choosing wisely or choosing rightly. The effects of stewardship rounds on timing and frequency of ID consultation are interesting. Further research into important patient outcomes and consultation practices are needed locally, but our experiences may help others to reflect on the power of conversation and relationships in antimicrobial stewardship.

scholarly journals Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

2019 ◽  
pp. bjgp1919X706625
Author(s):  
Laura Jefferson ◽  
Karl Atkin ◽  
Rebecca Sheridan ◽  
Steven Oliver ◽  
Una Macleod ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Interpersonal Communication ◽  
Framework Analysis ◽  
Face To Face ◽  
Individual Interviews ◽  
Urgent Referral ◽  
Cancer Services ◽  
Appointment System ◽  
The Uk ◽  
Organisational Factors

BackgroundThe 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5–7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes.AimTo examine how interpersonal, communication, social, and organisational factors influence a patient’s non-attendance.Design and settingQualitative study in GP practices in one Northern English city.MethodIn-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis.ResultsIn this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading ‘difficult lives’; and patients’ expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis. GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility.ConclusionFailure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.

scholarly journals How to strengthen clinical research in Shenzhen, China: qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024534
Author(s):  
Ping Ji ◽  
Hongling Chu ◽  
Chao Zhang ◽  
Ping Xiao ◽  
Min Liu ◽  
...  
Keyword(s):  
Focus Group ◽  
Qualitative Study ◽  
Clinical Research ◽  
Functional System ◽  
Research Subject ◽  
Semistructured Interview ◽  
Human Research ◽  
Individual Interviews ◽  
Human Research Subject ◽  
Training Programmes

ObjectivesTo better understand the strengths and weaknesses, and to propose policy recommendations, regarding conducting high-quality clinical research in Shenzhen, China.DesignA qualitative study conducted from August to November 2016 using a semistructured interview format involving both focus group interviews and individual interviews.SettingShenzhen, China.ParticipantsStratified purposive and convenience sampling were used. Thirty individuals experienced in conducting and managing clinical research were selected from key stakeholder groups, comprising 11 from local hospitals, 14 from pharmaceutical/medical device companies and 5 from government agencies.MethodsA semistructured interview guide was developed by the study group and used by experienced interviewers in focus group discussions and individual interviews. The interviewees were encouraged to share their opinions freely and discuss their own topics of interest during the interviews. Thematic analysis was used for analysis and all data were coded and extracted using NVivo V.11.0 software.ResultsFavourable driving factors for clinical research in Shenzhen identified by all stakeholders included the recent trend of increased governmental funding for clinical research, supportive governmental policies, wide recognition of the value of clinical research and high demands from local industry. The major challenges include a lack of technical infrastructure, weak human research subject protection and a lack of capable research resources.ConclusionsDespite the established strengths, Shenzhen still needs to develop suitable technical platforms, human resources training programmes and strong human research subject protection programmes pertaining to clinical research. This would facilitate the establishment of a functional system that can be expected to lead to increased medical research innovation in Shenzhen.

scholarly journals Non-attendance at urgent referral appointments for suspected cancer: a qualitative study to gain understanding from patients and GPs

2019 ◽  
Vol 69 (689) ◽  
pp. e850-e859 ◽  
Author(s):  
Laura Jefferson ◽  
Karl Atkin ◽  
Rebecca Sheridan ◽  
Steven Oliver ◽  
Una Macleod ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Interpersonal Communication ◽  
Framework Analysis ◽  
Face To Face ◽  
Individual Interviews ◽  
Urgent Referral ◽  
Cancer Services ◽  
Appointment System ◽  
The Uk ◽  
Organisational Factors

BackgroundThe 2-week-wait urgent referral policy in the UK has sought to improve cancer outcomes by accelerating diagnosis and treatment. However, around 5–7% of symptomatic referred patients cancel or do not attend their hospital appointment. While subsequent cancer diagnosis was less likely in non-attenders, those with a diagnosis had worse early mortality outcomes.AimTo examine how interpersonal, communication, social, and organisational factors influence a patient’s non-attendance.Design and settingQualitative study in GP practices in one Northern English city.MethodIn-depth, individual interviews were undertaken face-to-face or by telephone between December 2016 and May 2018, followed by thematic framework analysis.ResultsIn this study 21 GPs, and 24 patients who did not attend or had cancelled their appointment were interviewed, deriving a range of potential explanations for non-attendance, including: system flaws; GP difficulties with booking appointments; patient difficulties with navigating the appointment system, particularly older patients and those from more deprived areas; patients leading ‘difficult lives’; and patients’ expectations of the referral, informed by their beliefs, circumstances, priorities, and the perceived prognosis. GPs recognised the importance of communication with the patient, particularly the need to tailor communication to perceived patient understanding and anxiety. GPs and practices varied in their responses to patient non-attendance, influenced by time pressures and perceptions of patient responsibility.ConclusionFailure to be seen within 2 weeks of urgent referral resulted from a number of patient and provider factors. The urgent referral process in general practice and cancer services should accommodate patient perceptions and responses, facilitate referral and attendance, and enable responses to patient non-attendance.

scholarly journals Antimicrobial dispensing practices and determinants of antimicrobial resistance: a qualitative study among community pharmacists in Pakistan

2019 ◽  
Vol 7 (3) ◽  
pp. e000138 ◽  
Author(s):  
Zikria Saleem ◽  
Mohamed Azmi Hassali ◽  
Furqan Khurshid Hashmi ◽  
Brian Godman ◽  
Fahad Saleem
Keyword(s):  
Antimicrobial Resistance ◽  
Qualitative Study ◽  
Community Pharmacists ◽  
Subsequent Development ◽  
Antimicrobial Use ◽  
Semistructured Interview ◽  
Face To Face ◽  
Interview Guide ◽  
Dispensing Practices ◽  
Points Of View

BackgroundThere are concerns with the extent of dispensing of antibiotics among community pharmacists in Pakistan often without a prescription adding to antimicrobial resistance (AMR) rates.ObjectiveTo explore the determinants of AMR and the pattern of antimicrobial dispensing among community pharmacists.DesignIn this qualitative study design, a semistructured interview guide was developed based on an in-depth review of published papers. Audio-recorded interviews with transcripts were analysed by thematic content analysis.SettingInterviews were conducted among community pharmacists in Lahore, Pakistan.ParticipantsIn order to obtain individual points of view, in-depth face-to-face interviews with purposively selected pharmacists were conducted.ResultsA total of 12 pharmacists were interviewed for the study. After analysis, four major themes emerged: (1) knowledge and perception of community pharmacists about antimicrobials, (2) antimicrobial dispensing practices of community pharmacists, (3) determinants of AMR, (4) potential interventions to control AMR. Most of the pharmacists have limited knowledge about AMR, antimicrobial stewardship programmes and related guidelines. However, all the pharmacists strongly agreed that different appropriate actions should be taken in order to rationalise future antimicrobial use.ConclusionThe results indicated that irrational antimicrobial dispensing and use is common among community pharmacists in Pakistan owing to lack of knowledge. The community pharmacists perceived that behaviour of patients and the societal environment contributed to irrational antimicrobial use and subsequent development of AMR. They suggested a need for a multidisciplinary framework in order to improve future antimicrobial use and reduce AMR in Pakistan.

Perceptions of Distressed Fathers in the Early Postpartum Period: A Descriptive Qualitative Study

2020 ◽  
pp. 0192513X2098004
Author(s):  
Koh Yuan Ling Marjorie ◽  
Tan Li Cheng Anna ◽  
Shefaly Shorey
Keyword(s):  
Qualitative Study ◽  
Thematic Analysis ◽  
Health Care Professionals ◽  
Postpartum Period ◽  
Semistructured Interview ◽  
Face To Face ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
Mental Health Difficulties ◽  
Descriptive Qualitative

Current literature lacks qualitative information derived from distressed fathers. The aim of this study was to explore distressed fathers’ experiences and needs in the early postpartum period. A descriptive qualitative study design was used. The study took place from October 2018 to December 2018 at the tertiary public hospital in Singapore. A purposive sample of 12 distressed Singaporean fathers were interviewed in this study. Audio recorded interviews were conducted face-to-face using a semistructured interview guide and thematic analysis was used to analyze the data. Six themes emerged from the thematic analysis: (a) facing the “real deal,” (b) everyday woes, (c) “losing excitement,” (d) “trying to be strong,” (e) “reality check,” and (f) supplementing help for fathers. This study highlights distressed father’s agony and the urgent need for health care professionals and family members to seek acceptability and understanding of fathers’ mental health difficulties in the early postpartum period.

scholarly journals Challenges of Patients with Spinal Cord Injury During the COVID-19 Pandemic: A Qualitative Study

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Masoud Hatefi ◽  
Milad Borji ◽  
Yousef Jamshidbeigi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Qualitative Study ◽  
Code Of Ethics ◽  
Medical Sciences ◽  
Face To Face ◽  
Individual Interviews ◽  
Physical Support ◽  
Cord Injury ◽  
Data Saturation

Background: Spinal cord injury (SCI) is a chronic condition leading to physical and psychological problems along with numerous economic burdens for patients. In late 2019, an unknown disease called COVID-19 broke out, which quickly spread throughout the world. Objectives: The aim of the present study was to determine the challenges of SCI patients during the COVID-19 pandemic. Methods: This was a qualitative study performed among SCI patients after obtaining the code of ethics from the Research Ethics Committee of Ilam University of Medical Sciences in 2021. Data were collected using semi-structured, face-to-face individual interviews, in accordance with health protocols, in a safe environment without stress until reaching data saturation. Data were saturated after interviewing nine patients; to ensure data saturation, two additional interviews were conducted. Each interview lasted between 30 and 45 minutes, depending on the condition of each patient. The written files of the interviews were analyzed using MAXQDA software. Results: The mean age of the participants was 54 years, and 68% of the participants were male. After analyzing the data obtained from in-person interviews, three main themes, including expectations (need for financial support, need for social support, and need for physical support), concerns (fear of loneliness and fear of death), and health needs (health literacy, access to services and how to transmit the disease), were extracted. Conclusions: Considering the challenges in the three areas of expectations, concerns, and health care, it is necessary to take some measures to reduce these challenges.

Implementing antimicrobial stewardship in the Australian private hospital system: a qualitative study

2015 ◽  
Vol 39 (3) ◽  
pp. 315 ◽  
Author(s):  
Menino O. Cotta ◽  
Megan S. Robertson ◽  
Caroline Marshall ◽  
Karin A. Thursky ◽  
Danny Liew ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Antimicrobial Stewardship ◽  
Private Hospital ◽  
Effective Means ◽  
Public Hospitals ◽  
Semistructured Interview ◽  
Private Hospitals ◽  
Hospital System ◽  
Hospital Sector ◽  
Organisational Factors

Objective To explore organisational factors and barriers contributing to limited uptake of antimicrobial stewardship (AMS) in Australian private hospitals and to determine solutions for AMS implementation. Methods A qualitative study using a series of focus group discussions was conducted in a large private hospital making use of a semistructured interview guide to facilitate discussion among clinical and non-clinical stakeholders. A thematic analysis using five sequential components that mapped and interpreted emergent themes surrounding AMS implementation was undertaken by a multidisciplinary team of researchers. Results Analysis revealed that autonomy of consultant specialists was perceived as being of greater significance in private hospitals compared with public hospitals. Use of an expert team providing antimicrobial prescribing advice and education without intruding on existing patient–specialist relationships was proposed by participants as an acceptable method of introducing AMS in private hospitals. There was more opportunity for nursing and pharmacist involvement, as well as empowering patients. Opportunities were identified for the hospital executive to market an AMS service as a feature that promoted excellence in patient care. Conclusions Provision of advice from experts, championing by clinical leaders, marketing by hospital executives and involving nurses, pharmacists and patients should be considered during implementation of AMS in private hospitals. What is known about the topic? Hospital-wide AMS programs have been shown to be an effective means to address the problem of accelerating antimicrobial resistance. However, current literature predominantly focuses on evaluation of AMS activities rather than on improving implementation success. In addition, most research on hospital AMS programs is from the public hospital sector. AMS is now part of new National Safety and Quality Health Service accreditation standards mandatory for all Australian hospitals; however, uptake of AMS in private hospitals lags behind public hospitals. Australian private hospitals are fundamentally different to public hospitals and there is more information needed to determine how AMS can best be introduced in these hospitals. What does this paper add? Further investigation on how AMS can be implemented into private hospitals is urgently required. The qualitative work detailed in the present study provides a means of tailoring AMS strategies on the basis of organisational factors that may be considered unique to Australian private hospitals. What are the implications for practitioners? Clinical and hospital executive stakeholders in the private hospital sector will be able to use solutions presented herein as a blueprint for designing sustainable AMS programs within their private healthcare facilities.

scholarly journals Increasing Voluntary Public Health Reporting to the NHSN Antimicrobial Use Option

2020 ◽  
Vol 41 (S1) ◽  
pp. s296-s297
Author(s):  
Heather Dubendris ◽  
Amy Webb ◽  
Melinda Neuhauser ◽  
Arjun Srinivasan ◽  
Wendy Wise ◽  
...  
Keyword(s):  
Public Health ◽  
Antimicrobial Stewardship ◽  
Self Report ◽  
Antimicrobial Use ◽  
Health Departments ◽  
Public Health Reporting ◽  
Use Stage ◽  
Education And Development ◽  
Health Registry ◽  
Over Time

Background: The CDC NHSN launched the Antimicrobial Use Option in 2011. The Antimicrobial Use Option allows users to implement risk-adjusted antimicrobial use benchmarking within- and between- facilities using the standardized antimicrobial administration ratio (SAAR) and to evaluate use over time. The SAAR can be used for public health surveillance and to guide an organization’s stewardship or quality improvement efforts. Methods: Antimicrobial Use Option enrollment grew through partner engagement, targeted education, and development of data benchmarking. We analyze enrollment over time and discuss key drivers of participation. Results: Initial 2011 Antimicrobial Use Option enrollment efforts awarded grant Funding: to 4 health departments. These health departments partnered with hospitals, which encouraged vendors to build infrastructure for electronic antimicrobial use reporting. CDC supported vendors through outreach and education. In 2012, with CDC support, Veterans’ Affairs (VA) Informatics, Decision-Enhancement, and Analytic Sciences Center and partners began implementation of Antimicrobial Use Option reporting and validation of submitted data. These early efforts led to enrollment of 64 facilities by 2014 (Fig. 1). As awareness of the antimicrobial use option grew, we focused on facility engagement and development of benchmark metrics. A second round of grant Funding: in 2015 supported submission to the Antimicrobial Use Option from additional facilities by Funding: a vendor, a healthcare system, and an antimicrobial stewardship network. In 2015, CMS recognized the Antimicrobial Use Option as a choice for public health registry reporting under Meaningful Use Stage 3, resulting in an increase in participating hospitals. Antimicrobial Use Option enrollment increased in 2015 (n = 120), coinciding with national prioritization of antimicrobial stewardship. In 2016, the SAAR, was released in NHSN. We leveraged the SAAR to encourage participation from additional facilities and began quarterly calls to encourage continued participation from existing users. In 2016, the Department of Defense began submitting data to the Antimicrobial Use Option, resulting in 207 facilities enrolled in 2016, which grew to 616 in 2017. As of November 2019, 12 vendors self-report submission capabilities and 1,470 facilities, of ~6,800 active NHSN participants, are enrolled in the Antimicrobial Use Option. Two states have passed requirements regulating Antimicrobial Use Option reporting with Tennessee’s requirement going into effect in 2021. Conclusions: The Antimicrobial Use Option offers evidence that collaboration with partners, and leveraging of benchmarking metrics available to a national surveillance system can lead to increased voluntary participation in surveillance of high-priority public health data. Moving forward, we will continue expanding analytic capabilities and partner engagement.Funding: NoneDisclosures: None

scholarly journals Exploring the impact of a community participatory intervention on women's capability: a qualitative study in Gulu Northern Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Loubna Belaid ◽  
Emmanuel Ochola ◽  
Pontius Bayo ◽  
George William Alii ◽  
Martin Ogwang ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Social Status ◽  
Northern Uganda ◽  
Gender Inequalities ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Healthy Behaviors ◽  
Individual Interviews ◽  
Self Confidence ◽  
The Impact

Abstract Background Community participatory interventions mobilizing women of childbearing age are an effective strategy to promote maternal and child health. In 2017, we implemented this strategy in Gulu Northern Uganda. This study explored the perceived impact of this approach on women's capability. Methods We conducted a qualitative study based on three data collection methods: 14 in-depth individual interviews with participating women of childbearing age, five focus group discussions with female facilitators, and document analysis. We used the Sen capability approach as a conceptual framework and undertook a thematic analysis. Results Women adopted safe and healthy behaviors for themselves and their children. They were also able to respond to some of their family's financial needs. They reported a reduction in domestic violence and in mistreatment towards their children. The facilitators perceived improved communication skills, networking, self-confidence, and an increase in their social status. Nevertheless, the women still faced unfreedoms that deprived them of living the life they wanted to lead. These unfreedoms are related to their lack of access to economic opportunities and socio-cultural norms underlying gender inequalities. Conclusion To expand women's freedoms, we need more collective political actions to tackle gender inequalities and need to question the values underlying women's social status.

scholarly journals Older Adults’ Experiences of a Physical Activity and Sedentary Behaviour Intervention: A Nested Qualitative Study in the SITLESS Multi-Country Randomised Clinical Trial

2021 ◽  
Vol 18 (9) ◽  
pp. 4730
Author(s):  
Nicole Blackburn ◽  
Mathias Skjodt ◽  
Mark Tully ◽  
Ilona Mc Mullan ◽  
Maria Giné-Garriga ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Interaction ◽  
Qualitative Study ◽  
Management Strategies ◽  
Randomised Clinical Trial ◽  
Control Group ◽  
Individual Interviews ◽  
Perceived Effects ◽  
Qualitative Methodologies ◽  
Exercise Referral

Background: The SITLESS programme comprises exercise referral schemes and self-management strategies and has been evaluated in a trial in Denmark, Spain, Germany and Northern Ireland. The aim of this qualitative study was to understand the implementation and contextual aspects of the intervention in relation to the mechanisms of impact and to explore the perceived effects. Methods: Qualitative methodologies were nested in the SITLESS trial including 71 individual interviews and 12 focus groups targeting intervention and control group participants from postintervention to 18-month follow-up in all intervention sites based on a semi-structured topic guide. Results: Overarching themes were identified under the framework categories of context, implementation, mechanisms of impact and perceived effects. The findings highlight the perceived barriers and facilitators to older adults’ engagement in exercise referral schemes. Social interaction and enjoyment through the group-based programmes are key components to promote adherence and encourage the maintenance of targeted behaviours through peer support and connectedness. Exit strategies and signposting to relevant classes and facilities enabled the maintenance of positive lifestyle behaviours. Conclusions: When designing and implementing interventions, key components enhancing social interaction, enjoyment and continuity should be in place in order to successfully promote sustained behaviour change.

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