A systems thinking approach for antimicrobial stewardship in primary care

Author(s):  
Sajal K. Saha ◽  
David C.M. Kong ◽  
Danielle Mazza ◽  
Karin Thursky
Aquaculture ◽  
2021 ◽  
Vol 540 ◽  
pp. 736735
Author(s):  
Andrew P. Desbois ◽  
Maria Garza ◽  
Mahmoud Eltholth ◽  
Yamen M. Hegazy ◽  
Ana Mateus ◽  
...  

Author(s):  
Joanne Huang ◽  
Zahra Kassamali Escobar ◽  
Todd S. Bouchard ◽  
Jose Mari G. Lansang ◽  
Rupali Jain ◽  
...  

Abstract The MITIGATE toolkit was developed to assist urgent care and emergency departments in the development of antimicrobial stewardship programs. At the University of Washington, we adopted the MITIGATE toolkit in 10 urgent care centers, 9 primary care clinics, and 1 emergency department. We encountered and overcame challenges: a complex data build, choosing feasible outcomes to measure, issues with accurate coding, and maintaining positive stewardship relationships. Herein, we discuss solutions to challenges we encountered to provide guidance for those considering using this toolkit.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Travis B Nielsen ◽  
Maressa Santarossa ◽  
Beatrice D Probst ◽  
Laurie Labuszewski ◽  
Jenna Lopez ◽  
...  

Abstract Background Antimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs. Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing. The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary. This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting. Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions. Methods To achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance. Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign. The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics. Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval. Results Prescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates. However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials. Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019. Conclusion Reporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy. However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting. Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines. Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance. Disclosures All Authors: No reported disclosures


2020 ◽  
Vol 60 (5) ◽  
pp. e40-e43
Author(s):  
Jennifer M. Collins ◽  
Erin E. Dennis ◽  
Montgomery W. Green ◽  
Elisa M. Greene

2017 ◽  
Author(s):  
◽  
Umeoniso Joshua Osah

E-Government deployments by stakeholders within the South African water service sector, provide certain benefits for the sector. While deemed beneficial and of considerable value, e-Government deployments and implementations in the water sector of local governments of South Africa have not always been successful. One important reason for e-Government failures, among several others, is the lack of coherent strategies, informed by key representing stakeholder views, to guide implementation and deployment of e-Government tools. Without strategies, it is highly likely that ICT integration will be conducted haphazardly. As a point of note, more than the deliverable (strategy document) that represents the output of the strategy development process, it serves more purpose to understand the process that results in the strategy. Importantly, understanding the process helps to account for the formed relationships between the various stakeholders that need to buy into the strategy. The research study develops an e-Government strategy formulation framework based on a systems thinking approach, intended to support the strategy formulation process of e-Government strategies – to underpin the effective integration, deployment and sustained use of ICT solutions for water service delivery at the local government level. A systems thinking approach is considered due to its emphasis on the strategy being informed by a holistic assessment. Where there is some knowledge about the processes by which a strategy is formulated – over time ideas may be derived on the types of processes that may produce efficient e-Government strategies. The research is conducted using the Design Science research paradigm. The Design Science paradigm is comprised of two processes – build and evaluate (Hevner et al., 2004). The build process, as related to this research concentrates on the progression through which the theoretical e-Government strategy formulation framework is derived. Weick’s (1989) theorizing approach is ascribed, supporting the design of the theoretical framework. In applying Weick’s theorizing approach, firstly, the lack of knowledge on how e-Government strategies should be formulated in South African local municipalities – is explicated in an intelligible manner. Once the problem is properly articulated, a trial and error selection process is undertaken of existing approaches on strategy formulation – thought to possess the potential to contribute to the development of an e-Government strategy formulation framework, suited to local governments in South Africa. With good reason, 10 (ten) strategy approaches are selected from, e-Government programmes in developed countries, Non-Governmental organizational strategy approaches, and business related strategy formulation approaches. Lastly, as all possible approaches that may contribute to the framework development process cannot be selected, criteria is specified to limit the number of possible selections. Furthermore, in deriving the framework, foundations for systematically dealing with unstructured problems, such as, strategy formulation are consulted. This foundation along with the research goals, informs the development of a template used to comparatively analyse the 10 selected approaches on strategy formulation. This analysis aids in revealing the components of an e-Government strategy formulation process. With the developed framework, the evaluation process of the design science research commences, seeking to determine the utility of the framework (suitability and shortcomings). The framework is applied to the procedural formulation of a strategy for a tentative e-Government project called MobiSAM, which aims to enhance citizen engagement with local government through the use of mobile phones. The strategy formulation application process in the project environment and local government reveals lessons that inform revisions to the framework. The e-Government strategy formulation framework, therefore represents a fundamental tool for e-Government strategy development in local municipalities, and may be customized to fit the requirements of varying local municipalities.


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