scholarly journals Perceptions, views and practices regarding antibiotic prescribing and stewardship among hospital physicians in Jakarta, Indonesia

2021 ◽  
Author(s):  
Ralalicia Limato ◽  
Erni J. Nelwan ◽  
Manzilina Mudia ◽  
Monik Alamanda ◽  
Elfrida R. Manurung ◽  
...  
Keyword(s):  
Decision Making ◽  
Factor Analysis ◽  
Antimicrobial Resistance ◽  
Work Experience ◽  
Response Rate ◽  
Antibiotic Prescribing ◽  
List Type ◽  
Factor Scores ◽  
Public And Private ◽  
Hospital Physicians

AbstractObjectivesAntibiotic overuse is one of the main drivers of antimicrobial resistance (AMR), especially in low and middle-income countries. This study aimed to gain an understanding of perceptions, views, and practices regarding AMR, antibiotic prescribing, and stewardship (AMS) among hospital physicians in Jakarta, Indonesia.Designcross-sectional, self-administered questionnaire-based survey, with descriptive statistics, exploratory factor analysis (EFA) to identify distinct underlying constructs in the dataset, and multivariable linear regression of factor scores to analyse physician subgroups.SettingSix public and private general hospitals in Jakarta in 2019.Participants1007 of 1896 (53.1% response rate) antibiotic prescribing physicians.ResultsEFA identified six latent factors (overall Crohnbach’s α=0.85): awareness of AMS activities; awareness of AMS purpose; views regarding rational antibiotic prescribing; confidence in antibiotic prescribing decisions; perception of AMR as a significant problem; and immediate actions to contain AMR. Physicians acknowledged the significance of AMR and contributing factors, rational antibiotic prescribing, and purpose and usefulness of AMS. However, this conflicted with reported suboptimal local hospital practices, such as room cleaning, hand hygiene and staff education, and views regarding antibiotic decision-making. These included insufficiently applying AMS principles and utilising microbiology, lack of confidence in prescribing decisions, and defensive prescribing due to pervasive diagnostic uncertainty, fear of patient deterioration or because patients insisted. Physicians’ factor scores differed across hospitals, departments, work experience and medical hierarchy.ConclusionsAMS implementation in Indonesian hospitals is challenged by institutional, contextual and diagnostic vulnerabilities, resulting in externalising AMR instead of recognising it as a local problem. Appropriate recognition of the contextual determinants of antibiotic prescribing decision-making will be critical to change physicians’ attitudes and develop context-specific AMS interventions.Strengths and limitations of this studyThe self-developed questionnaire in this study identified a relevant set of attributes through a factor analysis optimization process, with adequate content, face and construct validity and internal reliability. This study adds important value in the absence of adequately validated instruments regarding antimicrobial resistance and stewardship, with particular applicability for LMIC.This study had a large, varied respondent sample and high response rate among physicians at six public and private hospitals in Jakarta, Indonesia, and identified differences between physicians across hospitals, departments, work experience and medical hierarchy, which can guide priority-setting and tailoring of stewardship interventions.However, non-participation and the convenient hospital sample could have introduced selection bias, and the data are not necessarily representative for Jakarta or Indonesia.Factor analysis is based on using a “heuristic”, which leaves room to more than one interpretation of the same data and cannot identify causality.

scholarly journals Contextual Factors Influencing Physicians’ Perception of Antibiotic Prescribing in Primary Care in Germany - A Prospective Observational Study

2021 ◽  
Author(s):  
Annika Queder ◽  
Christine Arnold ◽  
Michel Wensing ◽  
Regina Poß-Doering
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Logistic Regression ◽  
Antimicrobial Resistance ◽  
Observational Study ◽  
Work Experience ◽  
Prospective Observational Study ◽  
Contextual Factors ◽  
Antibiotic Prescribing ◽  
Perceived Impact

Abstract Background: Antimicrobial resistance is a worldwide challenge for health services and systems alike. To reduce the overuse of antibiotics, multifaceted interventions are often used to achieve sustainable effects. It can be assumed that these effects are influenced by contextual factors. Embedded in the cluster randomized trial ARena (Sustainable reduction of antibiotic-induced antimicrobial resistance), the aim of this present study was to identify contextual factors associated with practitioners’ perceptions of antibiotic prescribing in German primary health care. Methods: In a prospective observational study, data were generated in a three-wave survey study between January 2018 and July 2019. Analysis was performed using logistic regression models. The outcome of interest was the physician perceived impact of participating in the ARena project on decision-making regarding antibiotic prescribing, the independent variables of interest included individual characteristics, intervention arm allocation, primary care network (PCN) environment and characteristics of the medical practice.Results: 46.8% (n= 126) of participants indicated to have perceived an impact on their decision-making regarding antibiotic prescribing by participating in the ARena project. Bivariate logistic regression analyses indicated that work experience (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.006–1.103), PCN environment (OR 2.06, 95% CI 1.256–3.363), structural conditions (OR 1.66, 95% CI 1.161–2.371), environment of existing processes (OR 1.46, 95% CI 1.011–2.094), and externally defined general conditions (OR 1.57, 95% CI 1.035–2.378) were associated with physicians’ perceived impact of participating in the ARena project on decision-making regarding antibiotic prescribing. In the multivariate logistic regression analysis, only work experience OR 1.05 (95% CI 1.001–1.104) continuously showed a significant influence.Conclusions: This study indicates that contextual factors at individual, practice, and system level influence physicians’ perceptions of antibiotic prescribing. Trial registration: ISRCTN, ISRCTN58150046 (registered 13.09.2017).

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 A Virtual Standoff – Using Q Methodology to Analyze Virtual Reference

2007 ◽  
Vol 2 (4) ◽  
pp. 3 ◽  
Author(s):  
Aaron Shrimplin ◽  
Susan Hurst
Keyword(s):  
Decision Making ◽  
Factor Analysis ◽  
Q Methodology ◽  
Factor Scores ◽  
Virtual Reference ◽  
Reference Services ◽  
Wide Range ◽  
Reference Librarians ◽  
Actual Range ◽  
Points Of View

Abstract Objective - To develop an exploratory understanding of reference librarians’ perceptions of virtual reference. Methods – Q methodology was used to uncover points of view about virtual reference. Thirty-four librarians sorted 28 statements covering a wide range of opinions about virtual reference. Factor analysis was used to analyze the Q-sorts and factor scores were calculated to aid the task of understanding and interpretation. Results - The factor analysis revealed three attitudinal typologies: Technophiles, Traditionalists, and Pragmatists. Each factor represents a group of reference librarians who think similarly about virtual reference. Conclusions - This type of analysis provides data on the actual range of feelings and attitudes about providing virtual reference services. The factor analysis demonstrates that there are still a variety of strongly held viewpoints concerning virtual reference. Convergence towards either acceptance or rejection does not appear to be forthcoming. By using this type of analysis and the resulting data as a basis for decision making, administrators could staff services more efficiently and with the resulting better fit between librarians and their positions, possibly increase morale.

Contextual factors influencing physicians’ perception of antibiotic prescribing in primary care in Germany - A prospective observational study

2021 ◽  
Author(s):  
Annika Queder ◽  
Christine Arnold ◽  
Michel Wensing ◽  
Regina Poß-Doering
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Logistic Regression ◽  
Observational Study ◽  
Work Experience ◽  
Prospective Observational Study ◽  
Contextual Factors ◽  
System Level ◽  
Antibiotic Prescribing ◽  
Perceived Impact

Abstract BackgroundAntimicrobial resistance is a worldwide challenge for health services and systems alike. To reduce the overuse of antibiotics, multifaceted interventions are often used to achieve sustainable effects. It can be assumed that these effects are influenced by contextual factors. Embedded in the cluster randomized trial ARena (Sustainable reduction of antibiotic-induced antimicrobial resistance), the aim of this present study was to identify contextual factors associated with practitioners’ perceptions of antibiotic prescribing in German primary health care.MethodsIn a prospective observational study, data were generated in a three-wave survey study between January 2018 and July 2019. Analysis was performed using logistic regression models. The outcome of interest was the physician perceived impact of participating in the ARena project on decision-making regarding antibiotic prescribing, the independent variables of interest included individual characteristics, intervention arm allocation, primary care network (PCN) environment and characteristics of the medical practice.Results46.8% (n = 126) of participants indicated to have perceived an impact on their decision-making regarding antibiotic prescribing by participating in the ARena project. Bivariate logistic regression analyses indicated that work experience (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.006–1.103), PCN environment (OR 2.06, 95% CI 1.256–3.363), structural conditions (OR 1.66, 95% CI 1.161–2.371), environment of existing processes (OR 1.46, 95% CI 1.011–2.094), and externally defined general conditions (OR 1.57, 95% CI 1.035–2.378) were associated with physicians’ perceived impact of participating in the ARena project on decision-making regarding antibiotic prescribing. In the multivariate logistic regression analysis, only work experience OR 1.05 (95% CI 1.001–1.104) continuously showed a significant influence.ConclusionsThis study indicates that contextual factors at individual, practice, and system level influence physicians’ perceptions of antibiotic prescribing.Trial registrationISRCTN, ISRCTN58150046 (registered 13.09.2017).

scholarly journals Exploring antibiotic prescribing in public and private primary care settings in Singapore: a qualitative analysis informing theory and evidence-based planning for value-driven intervention design

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Huiling Guo ◽  
Zoe Jane-Lara Hildon ◽  
Victor Weng Keong Loh ◽  
Meena Sundram ◽  
Muhamad Alif Bin Ibrahim ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Care Delivery ◽  
Organisational Culture ◽  
Antibiotic Prescribing ◽  
Shared Decision ◽  
Publicly Funded ◽  
Public And Private ◽  
Primary Care Settings

Abstract Background Singapore’s healthcare system presents an ideal context to learn from diverse public and private operational models and funding systems. Aim To explore processes underpinning decision-making for antibiotic prescribing, by considering 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 general practitioners (GP) working in private practices (solo, small and large). Data were analysed using applied thematic analysis following realist principles, synthesised into a theoretical model, informing solutions to appropriate antibiotic prescribing. Results Given Singapore’s lack of national guidelines for antibiotic prescribing in primary care, practices are currently non-standardised. Themes contributing to optimal prescribing related first and foremost to personal valuing of reduction in antimicrobial resistance (AMR) which was enabled further by organisational culture creating and sustaining such values, and if patients were convinced of these too. Building trusting patient-doctor relationships, supported by reasonable patient loads among other factors were consistently observed to allow shared decision-making enabling optimal prescribing. Transparency and applying data to inform practice was a minority theme, nevertheless underpinning all levels of optimal care delivery. These themes are synthesised into the VALUE model proposed for guiding interventions to improve antibiotic prescribing practices. These should aim to reinforce intrapersonal Values consistent with prioritising AMR reduction, and Aligning organisational culture to these by leveraging standardised guidelines and interpersonal intervention tools. Such interventions should account for the wider systemic constraints experienced in publicly funded high patient turnover institutions, or private clinics with transactional models of care. Thus, ultimately a focus on Liaison between patient and doctor is crucial. For instance, building in adequate consultation time and props as discussion aids, or quick turnover communication tools in time-constrained settings. Message consistency will ultimately improve trust, helping to enable shared decision-making. Lastly, Use of monitoring data to track and Evaluate antibiotic prescribing using meaningful indicators, that account for the role of shared decision-making can also be leveraged for change. Conclusions These VALUE dimensions are recommended as potentially transferable to diverse contexts, and the model as implementation tool to be tested empirically and updated accordingly.

scholarly journals Austrian Veterinarians’ Attitudes to Euthanasia in Equine Practice

Animals ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. 44
Author(s):  
Svenja Springer ◽  
Florien Jenner ◽  
Alexander Tichy ◽  
Herwig Grimm
Keyword(s):  
Decision Making ◽  
Work Experience ◽  
Response Rate ◽  
Companion Animals ◽  
Related Factors ◽  
Multiple Factors ◽  
Emotional Bonds ◽  
Veterinary Profession ◽  
Anonymous Questionnaire ◽  
Relational Factors

Euthanasia of companion animals is a challenging responsibility in the veterinary profession since veterinarians have to consider not only medical, but also legal, economic, emotional, social, and ethical factors in decision-making. To this end; an anonymous questionnaire-based survey of Austrian equine veterinarians examines the attitudes to the euthanasia of equine patients in a range of scenarios; to identify factors which may influence decisions on the ending of a horse’s life. This paper describes the distributions of demographic and attitude variables. Mann-Whitney U tests were used to test the associations of gender, work experience, and equine workload with attitudes in relation to euthanasia statements and case scenarios. In total, 64 respondents (response rate = 23.4%) completed the questionnaire. The study showed that veterinarians consider contextual and relational factors in their decision-making. They are aware of owners’ emotional bonds with their horses and financial background, however, requests for convenience euthanasia are typically rejected. Although some significant differences between the tested variables emerged, the attitudes of the veterinarians were shown to be largely shared. In conclusion, veterinarians are aware of the multiple factors that influence their decision-making and gave indications as to the weight of animal- and owner-related factors in the handling of euthanasia.

The Structure Among Measures of Personality, Social Attitudes, Values, and Social Norms

2007 ◽  
Vol 28 (4) ◽  
pp. 240-251 ◽  
Author(s):  
Lazar Stankov
Keyword(s):  
Factor Analysis ◽  
Individual Differences ◽  
Social Norms ◽  
Social Interactions ◽  
Correlation Matrix ◽  
Social Attitudes ◽  
Group Differences ◽  
Factor Scores ◽  
Ethnic Group Differences ◽  
Inside Out

Abstract. This paper presents the results of a study that employed measures of personality, social attitudes, values, and social norms that have been the focus of recent research in individual differences. These measures were given to a sample of participants (N = 1,255) who were enrolled at 25 US colleges and universities. Factor analysis of the correlation matrix produced four factors. Three of these factors corresponded to the domains of Personality/Amoral Social Attitudes, Values, and Social Norms; one factor, Conservatism, cut across the domains. Cognitive ability showed negative correlation with conservatism and amoral social attitudes. The study also examined gender and ethnic group differences on factor scores. The overall interpretation of the findings is consistent with the inside-out view of human social interactions.

Use of an Atrial Fibrillation Medication Decision Aid Improves Knowledge and Process for Decision Making (Preprint)

2018 ◽  
Author(s):  
Molly Beinfeld ◽  
Suzanne Brodney ◽  
Michael Barry ◽  
Erika Poole ◽  
Adam Kunin
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Anticoagulant Therapy ◽  
Decision Aid ◽  
Response Rate ◽  
Intervention Group ◽  
Shared Decision ◽  
Community Based ◽  
Baseline Group

BACKGROUND A rural community-based Cardiology practice implemented shared decision making supported by an evidence-based decision aid booklet to improve the quality of anticoagulant therapy decisions in patients with atrial fibrillation. OBJECTIVE To develop a practical workflow for implementation of an anticoagulant therapy decision aid and to assess the impact on patients’ knowledge and process for anticoagulant medication decision making. METHODS The organization surveyed all patients with atrial fibrillation being seen at Copley Hospital to establish a baseline level of knowledge, certainty about the decision and process for decision making. The intervention surveys included the same knowledge, certainty, process and demographic questions as the baseline surveys, but also included questions asking for feedback on the decision aid booklet. Stroke risk scores (CHA2DS2-VASc score) were calculated by Copley staff for both groups using EMR data. RESULTS We received 46 completed surveys in the baseline group (64% response rate) and 50 surveys in the intervention group (72% response rate). The intervention group had higher knowledge score than the baseline group (3.6 out of 4 correct answers vs 3.1, p=0.036) and Decision Process Score (2.89 out of 4 vs 2.09, p=0.0023) but similar scores on the SURE scale (3.12 out of 4 vs 3.17, p=0.79). Knowledge and Process score differences were sustained even after adjusting for co-variates in stepwise linear regression analyses. Patients with high school or lower education appeared to benefit the most from shared decision making, as demonstrated by their knowledge scores. CONCLUSIONS It is feasible and practical to implement shared decision making supported by decision aids in a community-based Cardiology practice. Shared decision making can improve knowledge and process for decision making for patients with atrial fibrillation. CLINICALTRIAL None

scholarly journals A survey of the knowledge and attitudes of Egyptian healthcare professionals towards the application of Health Information Technology to optimize antibiotic therapy

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i28-i28
Author(s):  
N Hassan ◽  
R Slight ◽  
S P Slight
Keyword(s):  
Information Technology ◽  
Developing Countries ◽  
Antimicrobial Resistance ◽  
Health Information Technology ◽  
Health Information ◽  
Antimicrobial Stewardship ◽  
Healthcare Professionals ◽  
Response Rate ◽  
Public Healthcare ◽  
P Value

Abstract Introduction Antimicrobial resistance is a global health problem, especially in developing countries. Antimicrobial Stewardship Programmes (AMS) have been shown to be effective at reducing antimicrobial resistance and hospital patient stays. Health information technology (HIT) can support Outpatient Parenteral Antimicrobial Therapy (OPAT) through more accurate diagnosis and management of infectious diseases. Aim To evaluate the knowledge and attitude of Egyptian healthcare professionals towards the application of HIT to optimize OPAT. Methods Healthcare professionals who worked in either private or public sectors of Egyptian healthcare system were emailed and asked if they would be willing to complete an electronic questionnaire (using google forms). One reminder was sent by email each week for two weeks (two in total) from the first invitation. The survey was laid out in four sections. The first section included specific details about the healthcare professional’s current employment and role, the second related to HIT services available in their organisations, the third covered their training in HIT and antimicrobial stewardship programmes, and the fourth included their use of HIT to optimize OPAT. Ethical approval was obtained from National Heart Institute, Egypt. Descriptive analysis was carried out for all the variables. One-way ANOVA testing at level of significance P-value <0.05, was used to compare numerical variables. SPSS version 26 was used for statistical analysis. Results Three hundred and eighty-five healthcare professionals were invited to respond to the questionnaire. (The response rate was 75.34% (290)). Of these, 152 (52.6%) were pharmacists, 134 (46.4%) physicians, and 3 (1%) nurses, and many participants (30.8%) had between 6 to 10 years of experience working in either outpatient or in-patient units. Only 15.2% of respondents mentioned that they have access to OPAT in their organizations, 51.2% did not have the service, while 33.6% responded that they did not know if the service was available. However, 27.3% had a training on ASP and 18.3% had a training on HIT. Mean scores for both knowledge (14.31±5.49) and attitude (14.67±2.53) were significantly higher in professionals who had received training in HIT (p = 0.003 & 0.006 respectively). However, scores for attitude were better than scores for knowledge. Conclusions In developing countries, HIT applications in OPAT are still in their infancy with only a few organisations adopting them. Egyptian healthcare professionals showed positive attitudes towards HIT use, especially when their knowledge was improved through training. Two strengths of this study include our high response rate and the wide breadth of different healthcare professionals who responded from both private and public healthcare settings. However, being a questionnaire, some questions were left unanswered and some respondents may not have been aware of their reasons for a particular answer. That said, this study has important implications for practice, with more awareness amongst healthcare professionals required on the availability of HIT services in their hospitals and how further training may be needed on the applications of HIT in optimizing OPAT.

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