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

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.

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Patients’ views about screening for atrial fibrillation (AF): a qualitative study in primary care

BMJ Open ◽

10.1136/bmjopen-2019-033061 ◽

2020 ◽

Vol 10 (3) ◽

pp. e033061

Author(s):

Mark Lown ◽

Christopher R Wilcox ◽

Stephanie Hughes ◽

Miriam Santer ◽

George Lewith ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Qualitative Study ◽

Decision Aids ◽

Care Practice ◽

Semistructured Interview ◽

Interview Guide ◽

Registration Number ◽

The Cost ◽

Inductive Thematic Analysis

ObjectivesThere has been increased interest in screening for atrial fibrillation (AF) with commissioned pilot schemes, ongoing large clinical trials and the emergence of inexpensive consumer single-lead ECG devices that can be used to detect AF. This qualitative study aimed to explore patients’ views and understanding of AF and AF screening to determine acceptability and inform future recommendations.SettingA single primary care practice in Hampshire, UK.Participants15 participants (11 female) were interviewed from primary care who had taken part in an AF screening trial. A semistructured interview guide was used flexibly to enable the interviewer to explore any relevant topics raised by the participants. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis.ResultsParticipants generally had an incomplete understanding of AF and conflated it with other heart problems or with raised blood pressure. With regards to potential drawbacks from screening, some participants considered anxiety and the cost of implementation, but none acknowledged potential harms associated with screening such as side effects of anticoagulation treatment or the risk of further investigations. The screening was generally well accepted, and participants were generally in favour of engaging with prolonged screening.ConclusionsOur study highlights that there may be poor understanding (of both the nature of AF and potential negatives of screening) among patients who have been screened for AF. Further work is required to determine if resources including decision aids can address this important knowledge gap and improve clinical informed consent for AF screening.Trial registration numberISRCTN 17495003.

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Physicians' Perspective on Prescribing Patterns and Knowledge on Antimicrobial Use and Resistance in Penang, Malaysia: A Qualitative Study

Frontiers in Public Health ◽

10.3389/fpubh.2020.601961 ◽

2020 ◽

Vol 8 ◽

Author(s):

Ali Akhtar ◽

Amer Hayat Khan ◽

Hadzliana Zainal ◽

Mohamed Azmi Ahmad Hassali ◽

Irfhan Ali ◽

...

Keyword(s):

Health Care ◽

Antimicrobial Resistance ◽

Qualitative Study ◽

Health Care System ◽

Tertiary Care ◽

Prescribing Patterns ◽

Antimicrobial Use ◽

Prescribing Practices ◽

The Impact ◽

Care System

Background: Unnecessary antimicrobial use is an emerging problem throughout the world. To design future interventions to ensure rational antimicrobial use and decrease the risk of antimicrobial resistance, physician's knowledge and prescribing practices of antimicrobials should be assessed. Therefore, the main objective of this study is to investigate the physician's knowledge along with their prescribing patterns of antimicrobials in their health care system.Methods: The present qualitative study was conducted in a tertiary care public hospital located at Penang island, situated in Northwest of Malaysia. A total of 12 semi-structured, face to face interviews were conducted with purposive sampling technique. Physicians recruited had different specialties. All interviews were audio recorded, then transcribed into English language and analyze by thematic content analysis.Results: Four major themes were identified: (1) prescribing patterns of physicians regarding antimicrobials; (2) physician's knowledge about antimicrobials; (3) antimicrobial resistance; (4) satisfaction with management of infections. Physicians believed in regular educational activities and updates about the latest antimicrobial guidelines may change the prescribing behavior of physicians to optimize the use of antimicrobials. This may lead to decrease in burden of antimicrobial resistance in their health care system. Physicians emphasized that stricter rules and regular monitoring of antimicrobial use should be implemented to overcome the main challenges of antimicrobial resistance.Conclusion: Different factors were identified to assist optimized use of antimicrobials and decrease the risk of antimicrobial resistance. The present study helps to design targeted future interventions to ensure rational antimicrobial use and decrease the impact of antimicrobial resistance in Malaysia.

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Views of Community Pharmacists on Antimicrobial Resistance and Antimicrobial Stewardship in Jordan: A Qualitative Study

10.20944/preprints202103.0105.v1 ◽

2021 ◽

Author(s):

Doaa Saleh ◽

Rana Abu Farha ◽

Tareq Mukattash ◽

Muna Barakat ◽

Eman Alefishat

Keyword(s):

Antimicrobial Resistance ◽

Qualitative Study ◽

Antimicrobial Stewardship ◽

Action Plan ◽

Pharmacy Practice ◽

Community Pharmacists ◽

Academic Disciplines ◽

World Health ◽

Community Pharmacies ◽

Stewardship Program

The Center for Disease Control and Prevention and the World Health Organization issued a practical approach and Global Action Plan to control the threatening emerging antibacterial resistance. One of the main basis of this plan is the Antimicrobial Stewardship Program (ASPs). This study aimed to evaluate community pharmacists’ awareness and perception towards antimicrobial resistance and ASPs in Jordan. Thus, a qualitative study was conducted through in-depth interviews with twenty community pharmacists. Convienience sampling was used in the study. Qualitative analysis of the data yielded four themes and eleven sub-themes. All the respondents showed good understanding about the causes of antimicrobial resistance. The most important causes reported by them was the non-restricted prescription of antimicrobials. Most of the pharmacists believed that they are competent to provide ASPs, however, they believed that there are several barriers against the implementation of ASPs in community pharmacies in Jordan. Barriers demonstrated by the pharmacists, including organizational obstacles, resources obstacles, and personal obstacles. As a conclusion, this study revealed several barriers against the implementation of ASPs in community pharmacies in Jordan. Incorporating ASPs in the community pharmacy settings requires proper pharmacist training, several academic disciplines team efforts, and good pharmacy practice of antimicrobial guidelines.

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Qualitative Study of Community Pharmacists’ and General Practitioners’ Views toward Pharmacovigilance in Lithuania

Healthcare ◽

10.3390/healthcare9081072 ◽

2021 ◽

Vol 9 (8) ◽

pp. 1072

Author(s):

Agne Valinciute-Jankauskiene ◽

Loreta Kubiliene

Keyword(s):

Qualitative Study ◽

General Practitioners ◽

Patient Outcomes ◽

Medication Management ◽

Community Pharmacists ◽

Basic Knowledge ◽

Pharmacovigilance System ◽

Face To Face ◽

Study Approach ◽

Baltic Countries

Lithuania is the leader in pharmacovigilance among the three Baltic countries. However, comparisons with other European countries are difficult because the reported number of adverse drug reactions (ADRs) in Lithuania is too low to rely on in terms of the annual use of medicines by the population over the year. The aim of this study was to explore challenges related to the understanding and practices of general practitioners and community pharmacists in reporting ADRs in Lithuania. The qualitative study approach of face-to-face interviews was used. All interviews were recorded, transcribed verbatim, and thematically analyzed. Twelve interviews with general practitioners and community pharmacists were conducted from March 2020 through December 2020. All participants had a basic knowledge of pharmacovigilance, but only four participants reported ADRs to the interviewer. Six main barriers regarding ADR reporting were identified, and appropriate interventions were suggested. The importance of collaboration between physicians and pharmacists was highlighted, and the need for guidelines supporting collaboration was expressed. Medications are becoming more complex, and comprehensive medication management is key for the optimization of patient outcomes. Our results reveal the need to improve and innovate the current pharmacovigilance system at all levels, starting from education for pharmacy and healthcare students and continuing through the development of ADR procedures.

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

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.175 ◽

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.

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Exploring the Perceptions of Nurses on Receiving the SARS CoV-2 Vaccine in Palestine: A Qualitative Study

Canadian Journal of Nursing Research ◽

10.1177/08445621211066721 ◽

2021 ◽

pp. 084456212110667

Author(s):

Souad Belkebir ◽

Beesan Maraqa ◽

Zaher Nazzal ◽

Abdullah Abdullah ◽

Ferial Yasin ◽

...

Keyword(s):

Social Media ◽

Qualitative Study ◽

Vaccine Development ◽

Scientific Information ◽

Face To Face ◽

Template Analysis ◽

Interview Guide ◽

Paper Form ◽

Nurses Perceptions ◽

Vaccine Information

Background Uncertainty about vaccination among nurses are major barriers to managing the ongoing COVID-19 pandemic worldwide. Purpose To explore nurseś perceptions about receiving the SARS CoV-2 vaccine to inform the upcoming Palestinian Ministry of Health (MOH) vaccination efforts. Methods Four focus groups were conducted with nurses between January 18 and 30, 2021, before MOH launched vaccinations in Palestine. Participants working in government and private facilities were invited to participate and completed an online or paper form to provide demographics, review the study purpose, and give consent. Meetings were facilitated in Arabic either online via the Zoom platform or face-to-face using the same interview guide. Transcripts were translated into English and coded using a template analysis approach. Results Forty-six nurses, with a median age of 29.5y (range, 22–57) from across Palestine participated. Three major themes emerged: uncertainty, trust, and the knowledge needed to move forward. Uncertainty related to the evolving nature of COVID-19, the rapidity of vaccine development, the types and timing of available vaccines. The need for trusted experts to share scientific information about the vaccines to counteract the misinformation in social media. Moreover, reliable vaccine information may help vaccine-hesitant nurses move to vaccine-acceptors and to convince others, including their patients. Conclusion The negative perception of nurses towards vaccines is problematic in Palestine and uncertainty about which vaccine(s) will be available adds to the lack of education and mass-media misinformation. Other countries with vaccination efforts that are not wholly planned or implemented and may be struggling with similar concerns.

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Mothers’ Reactions to Seeing Their Children With Cleft for the First Time: A Qualitative Study in Ghana

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620965407 ◽

2020 ◽

pp. 105566562096540

Author(s):

Jonathan Mensah Dapaah ◽

Bright Addo ◽

Jones Phebe Effe

Keyword(s):

Primary Caregivers ◽

Qualitative Description ◽

Semistructured Interview ◽

Psychosocial Effects ◽

Face To Face ◽

Health Care Practitioners ◽

Interview Guide ◽

First Time ◽

Emotional Effects ◽

Depth Interviews

Objective: Studies on the etiology, treatment, and psychosocial effects of clefts among children born with the condition abound. Limited studies, however, have focused on the mothers of these children. This study aimed to explore the immediate reaction of mothers to seeing their children born with a cleft for the first time. Mothers’ knowledge of cleft and the support systems available to them were also explored. Design: Employing a qualitative description approach, data were collected through face-to-face individual in-depth interviews using a semistructured interview guide. Participants and Research Context: Using the purposive and snowballing sampling techniques, 12 mothers who sought treatment for their children with cleft at a Tertiary health facility in Ghana were selected. The ethical principles outlined in the Declaration of Helsinki were followed during data collection. The data obtained were analyzed applying the technique of thematic analysis. Results: Mothers’ first time reaction to seeing their child born with a cleft was that of sadness, worry, and disappointment. Knowledge of cleft among the mothers was low with most of them knowing more about the condition only after the delivery of their child with a cleft. Mothers received support from family members, health care practitioners, nongovernmental organizations, and their partners. Conclusion: To reduce the psychosocial and emotional effects resulting from mothers giving birth to a child with a cleft, information on the condition should be made available to mothers and primary caregivers early enough.

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

Journal of Family Issues ◽

10.1177/0192513x20980042 ◽

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.

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Views of Community Pharmacists on Antimicrobial Resistance and Antimicrobial Stewardship in Jordan: A Qualitative Study

Antibiotics ◽

10.3390/antibiotics10040384 ◽

2021 ◽

Vol 10 (4) ◽

pp. 384

Author(s):

Doaa Saleh ◽

Rana Abu-Farha ◽

Tareq L. Mukattash ◽

Muna Barakat ◽

Eman Alefishat

Keyword(s):

Antimicrobial Resistance ◽

Qualitative Study ◽

Antimicrobial Stewardship ◽

Action Plan ◽

Pharmacy Practice ◽

Community Pharmacists ◽

Academic Disciplines ◽

World Health ◽

Community Pharmacies ◽

Stewardship Program

The Center for Disease Control and Prevention and the World Health Organization issued a practical approach and Global Action Plan to control the threatening emerging antibacterial resistance. One of the main bases of this plan is the Antimicrobial Stewardship Program (ASPs). This study aimed to evaluate community pharmacists’ awareness and perception towards antimicrobial resistance and ASPs in Jordan. Thus, a qualitative study was conducted through in-depth interviews with twenty community pharmacists. Convenience sampling was used in the study. Qualitative analysis of the data yielded four themes and eleven sub-themes. All the respondents showed a good understanding of the causes of antimicrobial resistance. The most important cause reported by them was the non-restricted prescription of antimicrobials. Most of the pharmacists believed that they are competent to provide ASPs, however, they believed that there are several barriers against the implementation of ASPs in community pharmacies in Jordan. Barriers demonstrated by the pharmacists, included organizational obstacles, resources obstacles, and personal obstacles. In conclusion, this study revealed several barriers against the implementation of ASPs in community pharmacies in Jordan. Incorporating ASPs in the community pharmacy settings requires proper pharmacist training, several academic disciplines team efforts, and good pharmacy practice of antimicrobial guidelines.

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Strategies Adopted by Novice Nurse Educators to Facilitate Their Transition From Practice to Academia: A Qualitative Study in Ghana

SAGE Open Nursing ◽

10.1177/23779608211035209 ◽

2021 ◽

Vol 7 ◽

pp. 237796082110352

Author(s):

Timothy Tienbia Laari ◽

Felix Apiribu ◽

Timothy Gazari ◽

Moses Haruna Akor ◽

Adwoa Bemah Boamah Mensah ◽

...

Keyword(s):

Qualitative Study ◽

Performance Appraisal ◽

Nurse Educators ◽

Sampling Technique ◽

Transition Process ◽

Semistructured Interview ◽

Novice Nurse ◽

Wide Range ◽

Interview Guide ◽

Faculty Mentorship

Introduction The successful transition of nurses from clinical practice to academia is essential to the training of a proficient future nursing workforce. However, deprived of requisite support and guidance, novice nurse educators often find the transition from bedside nursing practice to the classroom challenging and hence, adopt some coping strategies to facilitate their transition. Yet, little is known about the strategies adopted by Ghanaian novice nurse educators to facilitate their transition. Objective This study explored the strategies adopted by novice nurse educators to facilitate their transition from practice to academia in three nursing training colleges in Ghana. Methods This study adopted a descriptive qualitative study design. The study used a purposive sampling technique to recruit 12 novice nurse educators. Data were generated through individual in-depth interviews using a semistructured interview guide. Interviews were audio-recorded, transcribed verbatim, and analyzed manually through thematic analysis. Results Novice nurse educators adopted a wide range of strategies to facilitate their transition from practice to academia. Four major themes emerged: (1) seeking support from peers, (2) attending workshops and conferences, (3) relying on performance appraisal and feedback, and (4) applying past clinical nursing knowledge. Conclusion The strategies adopted to facilitate the transition were mostly self-inspired and informal, which calls for more formal and evidence-based strategies to facilitate the transition process. College authorities must create, or adopt and modify faculty mentorship models to mentor novice nurse educators, develop and implement college-specific orientation programmes for novice nurse educators, and implement regular online tutor appraisals by students.

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