scholarly journals Factors Influencing Antibiotic-Prescribing Decisions Among Inpatient Physicians: A Qualitative Investigation

2015 ◽  
Vol 36 (9) ◽  
pp. 1065-1072 ◽  
Author(s):  
Daniel Livorsi ◽  
Amber Comer ◽  
Marianne S. Matthias ◽  
Eli N. Perencevich ◽  
Matthew J. Bair
Keyword(s):  
Decision Making ◽  
Adverse Effects ◽  
Teaching Hospitals ◽  
Inpatient Setting ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Structured Interviews ◽  
Prescribing Behavior ◽  
Face To Face ◽  
Direct Feedback

OBJECTIVETo understand the professional and psychosocial factors that influence physician antibiotic prescribing habits in the inpatient setting.DESIGNWe conducted semi-structured interviews with 30 inpatient physicians. Interviews consisted of open-ended questions and flexible probes based on participant responses. Interviews were audio recorded, transcribed, de-identified, and reviewed for accuracy and completeness. Data were analyzed using emergent thematic analysis.SETTINGTwo teaching hospitals in Indianapolis, IndianaPARTICIPANTSA total of 30 inpatient physicians (10 physicians-in-training, 20 supervising staff) were enrolled in this study.RESULTSParticipants recognized that antibiotics are overused, and many admitted to prescribing antibiotics even when the clinical evidence of infection was uncertain. Overprescription was largely driven by anxiety about missing an infection, whereas potential adverse effects of antibiotics did not strongly influence decision making. Participants did not routinely disclose potential adverse effects of antibiotics to inpatients. Physicians-in-training were strongly influenced by the antibiotic prescribing behavior of their supervising staff physicians. Participants sometimes questioned their colleagues’ antibiotic prescribing decisions, but they frequently avoided providing direct feedback or critique. These physicians cited obstacles of hierarchy, infrequent face-to-face encounters, and the awkwardness of these conversations.CONCLUSIONA physician-based culture of prescribing antibiotics involves overusing antibiotics and not challenging the decisions of colleagues. The potential adverse effects of antibiotics did not strongly influence decision making in this sample. A better understanding of these factors could be leveraged in future efforts to improve antibiotic prescribing practices in the inpatient setting.Infect. Control Hosp. Epidemiol. 2015;36(9):1065–1072

scholarly journals 512Challenges and opportunities to appropriate antibiotic prescribing: a survey of clinicians’ perceptions in Australia

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Mah Laka ◽  
Adriana Milazzo ◽  
Tracy Merlin
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Antibiotic Resistance ◽  
Inappropriate Prescribing ◽  
Patient Expectations ◽  
Antibiotic Prescribing ◽  
Global Public Health ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Prescribing Behavior

Abstract Background Emerging antibiotic resistance is significant threat to global public health. There is evidence on sub-optimal prescribing as a contributing factor to antibiotic resistance. This study aimed to identify behavioral determinants of antibiotic prescribing that may help design effective interventions. Methods A cross-sectional survey was undertaken with clinicians (hospital and primary care) in Australia from June–October 2019. Multivariate logistic regression was used to determine if clinicians’ characteristics, and guidelines’ use, are associated with barriers of appropriate antibiotic prescribing. Results Inappropriate prescribing behavior is not limited to clinicians’ practices, but also relate to patients’ expectation and clinical culture. Lack of data for evidence-based decision-making and diagnostic uncertainty contribute to sub-optimal antibiotic prescribing. Different care settings and clinicians’ experience influence perceptions of whether unavailability of information, delay in diagnostic results and patient expectations regarding treatment led to inappropriate prescribing behavior. Respondents in primary care and with less experience were more likely to consider that patient demands (primary care: OR 1.76, 95%CI 1.34–2.68 & experience (1-10 years): OR 1.34, 95%CI 1.07–1.59) and lack of data required for decision-making (primary care: OR 1.59, 95%CI 1.09–2.10 & experience (1-10 years): OR 1.63, 95%CI 1.13–1.87) are barriers to appropriate prescribing. Conclusions A complex network of social, contextual and clinical factors influence prescribing practices. A holistic approach addressing clinicians’ practices, setting requirements and patient expectations must be considered. Key messages For optimal antibiotic prescribing, there is a need to focus on contextual requirements, shared decision-making and availability of relevant information at point-of-care.

scholarly journals GPs’ insights about discontinuing long-term antidepressant use: a qualitative study

2021 ◽  
pp. BJGP.2020.0913
Author(s):  
Maria Donald ◽  
Riitta Partanen ◽  
Leah Sharman ◽  
Johanna Lynch ◽  
Genevieve A Dingle ◽  
...  
Keyword(s):  
Decision Making ◽  
Prescribing Practices ◽  
Structured Interviews ◽  
Relational Context ◽  
Qualitative Interview Study ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Antidepressant Use ◽  
Set Up

Background: There is considerable concern about increasing antidepressant use, with Australians among the highest users in the world. Evidence suggests this is driven by patients on long-term rather than new prescriptions. Most antidepressant prescriptions are generated in general practice and it is likely that attempts to discontinue are either not occurring or are proving unsuccessful. Aim: To explore GPs’ insights about long-term antidepressant prescribing. Design and Setting: A qualitative interview study with Australian GPs. Method: Semi-structured interviews explored GPs’ discontinuation experiences, decision-making, perceived risks and benefits, and support for patients. Data were analysed using reflexive thematic analysis. Results: Three overarching themes were identified from interviews with 22 GPs. The first, ‘Not a simple deprescribing decision’, speaks to the complex decision-making GPs undertake in determining whether a patient is ready to discontinue. The second, ‘A journey taken together’ captures a set of steps GPs take together with their patients to initiate and set-up adequate support before, during and after discontinuation. The third: ‘Supporting change in GPs’ prescribing practices’ describes what GPs would like to see change to better support them and their patients to discontinue antidepressants. Conclusions: GPs see discontinuation of long-term antidepressant use as more than a simple deprescribing decision. It begins with considering a patients’ social and relational context and is a journey involving careful preparation, tailored care and regular review. These insights suggest interventions to redress long-term use will need to take these considerations into account and be placed in a wider discussion about the use of antidepressants.

The ethics of incomprehensibility

2013 ◽  
Author(s):  
Giovanni Stanghellini
Keyword(s):  
Decision Making ◽  
Expert Knowledge ◽  
Single Word ◽  
Structured Interviews ◽  
Karl Jaspers ◽  
Face To Face ◽  
The Future ◽  
The Face ◽  
Therapeutic Protocols ◽  
Decision Making Criteria

What can psychiatrists learn today from Karl Jaspers, who at the dawn of XX Century, held that the future of medicine was in binding philosophy to science ? How can young psychiatrists, who are so hungry for handbook knowledge, structured interviews, decision-making criteria, and therapeutic protocols be so patient as to listen to such a hybrid clinician-philosopher arguing for a kind of knowledge which is stubbornly aware of its limits, and breathlessly revolting against all sorts of objectification and dogmatism? How can those who are looking for ‘expert knowledge’ be satisfied with a kind of knowledge which conceives of itself as an ‘unlimited task’ which takes place in the face-to-face, here-and-now encounter between two persons? How can they be happy with a mentor whose main teaching can be condensed into one sentence: ‘[Q]uestions are more essential than answers, and every answer becomes a new question’? To respond to these interrogations, we need to tackle another more fundamental one: On what kind of knowledge can we rely to establish the foundations of psychiatry? Jaspers’ answer can be condensed in one single word: Psychopathology.

Exploring the social ecology for appropriate antibiotic prescribing and stewardship in primary care: presenting the VALUE driven model of practice derived from qualitative analysis of public and private care settings in Singapore

2021 ◽  
Author(s):  
Huiling Guo ◽  
Zoe Jane-Lara Hildon ◽  
Victor Weng Keong Loh ◽  
Meena Sundram ◽  
Muhamad Alif Bin Ibrahim ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Care Delivery ◽  
Antibiotic Prescribing ◽  
Publicly Funded ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Optimal Care ◽  
Public And Private ◽  
Primary Care Settings

Abstract Background: Singapore’s healthcare system allows both antibiotic prescribing and dispensing across public and private primary care settings, presenting an ideal context to learn from systems where dispensing is closely tied to diverse operational models and funding mechanisms. Aim: To explore processes underpinning decision-making for antibiotic prescribing by primary care doctors in Singapore, by examining doctors’ experiences in different primary care settings. Methods: Thirty semi-structured interviews were conducted with 17 doctors working in publicly funded primary care clinics (polyclinics) and 13 doctors working in private general practitioner (GP) clinics (solo, small group and large group practices). Interviews were audio-recorded and transcribed verbatim. Data were analysed using applied thematic analysis. Results: Given the lack of National Guidelines for antibiotic prescribing in the Singapore context, this practice is currently non-standardised in both private and publicly funded primary care settings. Themes contributing to best practice narratives relate to having independent funding sources and control over drug formulary orders, and valuing reduction in antimicrobial resistance (AMR). The existence of trusting patient-doctor relationships, and reasonable patient loads were observed to allow joint participatory and informed decision-making that further enabled appropriate prescribing. The importance of monitoring and application of data/evaluations to inform practice was a minority theme, nevertheless underpinning all levels of optimal care delivery.Conclusions: A model for appropriate antibiotic prescribing-related interventions needs to prioritise addressing and shaping organisational and personal Valuing of AMR reduction. These values have to also Align with wider systemic constraints experienced in publicly funded institutions, operational management of private clinics and interactions with patients at the interpersonal level. The overcoming of such constraints and allowing time for patient Liaison and trust building will crystalise these earlier initiatives. Use of data to monitor and Evaluate antibiotic prescribing, informing optimal delivery systems should be routinely shared for transparency and to improve prescribing practices. These dimensions are summarised in the VALUE model for appropriate antibiotic prescribing and stewardship in primary care, which is recommended as transferable to diverse contexts.

scholarly journals Evaluating the Appropriateness of Antibiotic Treatment of Tonsillitis during COVID-19 in the North Wale Primary Healthcare Setting

2021 ◽  
Vol 12 ◽  
pp. 215013272110036
Author(s):  
Chunhei Li ◽  
Caitlin Ong ◽  
Anna Morris ◽  
Isobel Woollons ◽  
Ahsan Ashfaq ◽  
...  
Keyword(s):  
Primary Care ◽  
Healthcare Setting ◽  
Antibiotic Prescribing ◽  
Chi Square ◽  
Prescribing Behavior ◽  
Face To Face ◽  
The North ◽  
Remote Forcing ◽  
North Wales ◽  
Significant Difference

Background: The COVID-19 pandemic has changed the delivery of primary care in the NHS. Consultations have largely moved from face-to-face to remote, forcing practitioners to modify the ways in which they deliver care to patients. Aim: In this study, we aim to investigate the appropriateness of antibiotic prescribing in tonsillitis during the COVID-19 pandemic. Design and Setting: An observational quantitative analysis in the North Wales primary care setting. Method: Retrospective review of computer records across 5 GP centers from March 2020 until the end of October 2020. Data was extracted and analyzed using chi-square or fisher exact rank and Mann–Whitney test. Results: Our results have shown no significant difference in antibiotic prescribing behavior comparing face-to-face and remote consultations. Conclusion: Remote consultation is as effective as face-to-face consultation with regards to the assessment of tonsillitis and the appropriateness of antibiotic prescription in primary care.

scholarly journals Adapting ENABLE for patients with advanced cancer and their family caregivers in Singapore: a qualitative formative evaluation

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Grace Meijuan Yang ◽  
J. Nicholas Dionne-Odom ◽  
Yi Han Foo ◽  
Ariel Hui Mei Chung ◽  
Nur Haidah Ahmad Kamal ◽  
...  
Keyword(s):  
Decision Making ◽  
Family Caregivers ◽  
Advanced Cancer ◽  
Cancer Diagnosis ◽  
Formative Evaluation ◽  
Complementary Therapy ◽  
Healthcare Decision ◽  
Structured Interviews ◽  
Face To Face ◽  
Healthcare Decision Making

Abstract Background ENABLE (Educate, Nurture, Advise, Before Life Ends) is a nurse coach-led, early palliative care model for patients with advanced cancer and their family caregivers. Content covered includes problem-solving, advance care planning, symptom management and self-care. The aim was to evaluate the cultural acceptability of ENABLE among patients with advanced cancer and their caregivers in Singapore and identify modifications for an adapted ENABLE-SG model. Methods Qualitative formative evaluation with a thematic analysis approach in two hospitals in Singapore, involving patients (n = 10), family caregivers (n = 11) and healthcare professionals (n = 10) who care for patients with advanced cancer. Semi-structured interviews were conducted to explore (i) the main needs and challenges facing individuals with advanced cancer and their family caregivers; (ii) patient involvement in healthcare decision making; and (iii) content and delivery of ENABLE. Results While physical needs were largely well met, participants expressed that psychosocial care was delivered too late in the illness trajectory. Healthcare decision making approaches varied from a patient-centred shared decision-making model to a family-centred model where patients may not know their cancer diagnosis and prognosis. The content was considered to be relevant, comprehensive and practical; financial assistance, adjustment to body image, and evaluation of complementary therapy were also recommended. Face-to-face rather than telephone sessions were preferred to facilitate rapport building. Conclusions ENABLE was broadly acceptable with some modifications, including adjusting the content to ensure it can be delivered even if the patient is not fully aware of cancer diagnosis and delivering the first session face-to-face with flexibility for subsequent sessions.

scholarly journals Effect of a multifaceted stewardship intervention on antibiotic prescribing and outcomes for acute bacterial skin and skin structure infections

2018 ◽  
Vol 5 (6) ◽  
pp. 103-109
Author(s):  
Danya Roshdy ◽  
Rupal Jaffa ◽  
Kelly E. Pillinger ◽  
Josh Guffey ◽  
Nigel Rozario ◽  
...  
Keyword(s):  
Systemic Infection ◽  
Inpatient Setting ◽  
Antibiotic Prescribing ◽  
Intervention Period ◽  
Provider Education ◽  
Prescribing Practices ◽  
Post Intervention ◽  
Skin Structure ◽  
The Impact ◽  
Order Set

Background: Acute bacterial skin and skin structure infections (ABSSSI) are a leading cause of hospitalization, but are often treated inappropriately in the inpatient setting. A multifaceted stewardship intervention was implemented to encourage prescribing of guideline-concordant therapy (GCT). Objective: To examine the impact of this initiative on antimicrobial prescribing practices and patient outcomes. Methods: This was a single-center, retrospective study of adult inpatients admitted with a primary or secondary diagnosis of ABSSSI, classified by type and severity based on signs of systemic infection. Patients treated during the pre-intervention period (pre-IP) were compared with patients treated during the post-intervention period (post-IP). The primary endpoint was receipt of GCT. Secondary endpoints included receipt of anti-anaerobic antibiotic (AAA) or broad-spectrum antibiotics (BSA). Results: A total of 125 patients were included, 64 in the pre-IP and 61 in the post-IP. There was a statistically significant increase in prescribing of GCT during the post-IP compared with the pre-IP (14% versus 56%, p < 0.0001) and a decrease in use of AAA (56% versus 34%, p = 0.01). No difference was observed with use of BSA (16% versus 15%, p = 0.89). Use of the computerized order set during the post-IP was low (18%). There was a numerical, but non-significant reduction in 30-day readmission (14.1% versus 6.6%, p = 0.17). Conclusion: The multifaceted intervention was effective for improving prescribing of GCT for ABSSSI. Given low use of the computerized order set, improved prescribing seemed to be driven by provider education. Strategies around ongoing education may be key to sustain positive results of stewardship interventions.

Roles and functions of stakeholders in implementing energy retrofits in the hotel sector

2020 ◽  
Vol 38 (5) ◽  
pp. 737-751
Author(s):  
M.F.F. Fasna ◽  
Sachie Gunatilake
Keyword(s):  
Decision Making ◽  
Implementation Process ◽  
Decision Making Process ◽  
Structured Interviews ◽  
Content Type ◽  
Face To Face ◽  
Key Stakeholders ◽  
Energy Service ◽  
Hotel Sector ◽  
The Right

PurposeThe success of energy retrofits (ER) projects is highly dependent on the involvement of right stakeholders at the right stage. So far, little insight is available from previous literature on the involvement of different stakeholders during various stages of the ER decision-making process, and their roles and functions in the respective stages. This is specifically true in the context of Energy Service Company (ESCO) led ER projects, which is an emerging trend in the current context. Hence, this paper aims to investigate the roles and functions of stakeholders during different stages of an ESCO-led ER project in the hotel sector.Design/methodology/approachAn in-depth case study was conducted in a selected hotel building to gain insights into the roles and functions of stakeholders throughout the project stages. To collect the required data, face-to-face semi-structured interviews were conducted with seven selected respondents within the case.FindingsThe study identified nine key stakeholders that were involved during five different project stages along with their functions. Based on these identified functions, four main roles (i.e. decision-maker, performer, monitor/observer, and supporter) emerged that were reflective of the nature of the stakeholders' involvement in different stages of the decision-making process. Owner/client, facilities manager (FM), ESCO and architect attached to ESCO emerged as the key “decision-makers” during project implementation process.Originality/valueThe outcomes of this research would be useful in ensuring the proactive involvement of all the identified stakeholders in respective project stages of ESCO led ER projects in the hotel sector.

Influences on childhood immunisation decision-making in London's Gypsy and Traveller communities

2020 ◽  
Vol 29 (14) ◽  
pp. 822-826
Author(s):  
Nicola Ellis ◽  
Ellie Walker-Todd ◽  
Catherine Heffernan
Keyword(s):  
Decision Making ◽  
Focus Group ◽  
Antenatal Care ◽  
Family Support ◽  
Health Professionals ◽  
Child Rearing ◽  
Small Scale ◽  
Structured Interviews ◽  
Face To Face ◽  
Key Issues

Aims: Uptake of childhood immunisations is lower among Gypsy, Roma and Traveller (GRT) communities than in the general UK population. This small-scale study aimed to elicit insights from GRT mothers on their interaction with health services in London around childhood immunisations. The purpose was to inform a larger piece of work by the NHS England and Improvement (London) Public Health Commissioning Team to inform their planning to improve access to vaccination services for GRT communities in London. Study design: An exploratory qualitative study using semi-structured interviews and a focus group. Methods: There was purposive sampling of mothers from any GRT background from south-west London using snowballing methods. One focus group and three interviews were conducted. A thematic analysis approach was used. Results: A total of nine women were recruited and seven participated between March and April 2018. Five themes were identified: adherence with antenatal care, self-declared parenting expertise, family support, childhood immunisations, keep children healthy but ‘they say wait on the MMR until they are talking’. Conclusion: Compliance with antenatal care, strong parenting beliefs and cohesive family support are strong influences on decision-making regarding immunisations. The women interviewed emphasised their own expertise in child rearing. This was occasionally at odds with the health advice provided by health professionals. The women widely shared their experiences of health professionals with other family and community members and this impacted on others' intention to vaccinate. These are key issues that should be considered when trying to improve uptake of immunisations in GRT families in a face-to-face manner. Equally, it warrants further exploration in a larger-scale study to see whether this reflects the wider community and in order to tailor supplementary immunisation activities to improve uptake.

scholarly journals Role of point-of-care tests in the management of febrile children: a qualitative study of hospital-based doctors and nurses in England

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044510
Author(s):  
Edmond Li ◽  
Juan Emmanuel Dewez ◽  
Queena Luu ◽  
Marieke Emonts ◽  
Ian Maconochie ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Point Of Care Tests ◽  
University Teaching Hospitals ◽  
Doctors And Nurses

ObjectivesThe use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers’ views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England.Study designQualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically.SettingTwo university teaching hospitals in London and Newcastle.Participants24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses).ResultsThere were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1–2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely.ConclusionIn this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.

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