scholarly journals Antimicrobial stewardship in rural and remote primary health care: a narrative review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jun Wern Yau ◽  
Sze Mun Thor ◽  
Danny Tsai ◽  
Tobias Speare ◽  
Chris Rissel
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
Narrative Review ◽  
Rural And Remote ◽  
Antimicrobial Prescribing ◽  
Primary Health ◽  
Resistance Rates

Abstract Background Antimicrobial resistance is an emerging problem worldwide and poses a significant threat to human health. Antimicrobial stewardship programmes are being implemented in health systems globally, primarily in hospitals, to address the growing threat of antimicrobial resistance. Despite the significance of primary health care services in providing health care to communities, antimicrobial stewardship programmes are not well established in this sector, especially in rural and remote settings. This narrative review aims to identify in rural and remote primary health care settings the (1) correlation of antimicrobial resistance with antibiotic prescribing and volume of antibiotic use, (2) appropriateness of antimicrobial prescribing, (3) risk factors associated with inappropriate use/prescribing of antibiotics, and (4) effective antimicrobial stewardship strategies. Methods The international literature was searched for English only articles between 2000 and 2020 using specified keywords. Seven electronic databases were searched: Scopus, Cochrane, Embase, CINAHL, PubMed, Ovid Medline and Ovid Emcare. Publication screening and analysis were conducted using Joanna Briggs Institute systematic review tools. Results Fifty-one eligible articles were identified. Inappropriate and excessive antimicrobial prescribing and use directly led to increases in antimicrobial resistance. Increasing rurality of practice is associated with disproportionally higher rates of inappropriate prescribing compared to those in metropolitan areas. Physician knowledge, attitude and behaviour play important roles in mediating antimicrobial prescribing, with strong intrinsic and extrinsic influences including patient factors. Antimicrobial stewardship strategies in rural and remote primary health care settings focus on health care provider and patient education, clinician support systems, utility of antimicrobial resistance surveillance, and policy changes. Results of these interventions were generally positive with decreased antimicrobial resistance rates and improved appropriateness of antimicrobial prescribing. Conclusions Inappropriate prescribing and excessive use of antimicrobials are an important contributor to the increasing resistance towards antimicrobial agents particularly in rural and remote primary health care. Antimicrobial stewardship programmes in the form of education, clinical support, surveillance, and policies have been mostly successful in reducing prescribing rates and inappropriate prescriptions. The narrative review highlighted the need for longer interventions to assess changes in antimicrobial resistance rates. The review also identified a lack of differentiation between rural and remote contexts and Indigenous health was inadequately addressed. Future research should have a greater focus on effective interventional components and patient perspectives.

scholarly journals An urgent need for antimicrobial stewardship in Indigenous rural and remote primary health care

2019 ◽  
Vol 211 (1) ◽  
pp. 9 ◽  
Author(s):  
Asha C Bowen ◽  
Kathryn Daveson ◽  
Lorraine Anderson ◽  
Steven YC Tong
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Antimicrobial Stewardship ◽  
Rural And Remote ◽  
Primary Health

Disaster Management in Rural and Remote Primary Health Care: A Scoping Review

2021 ◽  
Vol 36 (3) ◽  
pp. 362-369
Author(s):  
Katie A. Willson ◽  
Gerard J. FitzGerald ◽  
David Lim
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Care ◽  
Disaster Management ◽  
Scoping Review ◽  
Health Care Professionals ◽  
Disaster Preparedness ◽  
Rural And Remote ◽  
Primary Health

AbstractObjective:This scoping review aims to map the roles of rural and remote primary health care professionals (PHCPs) during disasters.Introduction:Disasters can have catastrophic impacts on society and are broadly classified into natural events, man-made incidents, or a mixture of both. The PHCPs working in rural and remote communities face additional challenges when dealing with disasters and have significant roles during the Prevention, Preparedness, Response, and Recovery (PPRR) stages of disaster management.Methods:A Johanna Briggs Institute (JBI) scoping review methodology was utilized, and the search was conducted over seven electronic databases according to a priori protocol.Results:Forty-one papers were included and sixty-one roles were identified across the four stages of disaster management. The majority of disasters described within the literature were natural events and pandemics. Before a disaster occurs, PHCPs can build individual resilience through education. As recognized and respected leaders within their community, PHCPs are invaluable in assisting with disaster preparedness through being involved in organizations’ planning policies and contributing to natural disaster and pandemic surveillance. Key roles during the response stage include accommodating patient surge, triage, maintaining the health of the remaining population, instituting infection control, and ensuring a team-based approach to mental health care during the disaster. In the aftermath and recovery stage, rural and remote PHCPs provide long-term follow up, assisting patients in accessing post-disaster support including delivery of mental health care.Conclusion:Rural and remote PHCPs play significant roles within their community throughout the continuum of disaster management. As a consequence of their flexible scope of practice, PHCPs are well-placed to be involved during all stages of disaster, from building of community resilience and contributing to early alert of pandemics, to participating in the direct response when a disaster occurs and leading the way to recovery.

scholarly journals Antimicrobial prescribing patterns in a group of private primary health care clinics in South Africa

2007 ◽  
Vol 12 (1) ◽  
Author(s):  
Norah L Katende-Kyenda ◽  
Martie S Lubbe ◽  
Jan HP Serfontein ◽  
Ilse Truter
Keyword(s):  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
Prescribing Patterns ◽  
Antimicrobial Prescribing ◽  
Health Care Clinics ◽  
Primary Health

The aim of this study was to investigate the prescribing of antimicrobials in private primary health care in South Africa. ABSTRAK Die doel met hierdie studie was om die voorskryfpatrone van antimikrobiese middels in private primêre gesondheidsorginrigtings in Suid-Afrika te ondersoek.

scholarly journals The Mbeya Antimicrobial Stewardship Team: Implementing Antimicrobial Stewardship at a Zonal-Level Hospital in Southern Tanzania

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 107 ◽  
Author(s):  
Jeffrey W. Hall ◽  
Jeannette Bouchard ◽  
P. Brandon Bookstaver ◽  
Matthew S. Haldeman ◽  
Peter Kishimbo ◽  
...  
Keyword(s):  
South Carolina ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Community Pharmacies ◽  
Prescribing Practices ◽  
University Of South Carolina ◽  
Antimicrobial Prescribing ◽  
Resistance Rates ◽  
The University ◽  
New Generation

Background: In 2017, Mbeya Zonal Referral Hospital (MZRH) and the University of South Carolina (UofSC) agreed to collaboratively strengthen antimicrobial prescribing in the southern highlands of Tanzania and train a new generation of clinicians in responsible antimicrobial use. Methods: Key stakeholders and participants were identified and the Mbeya Antimicrobial Stewardship Team (MAST) was created. The team identified assets brought by the collaborators, and four investigations of baseline needs were developed. These investigations included (a) a baseline clinician survey regarding antimicrobial resistance and stewardship, (b) a serial chart review of inpatient antimicrobial prescribing practices, (c) an investigation of antimicrobial resistance rates using existing isolates at the MZRH laboratory, and (d) a survey of antimicrobial availability at community pharmacies in the city. Results: 91% of physicians believe antimicrobial resistance is problem in Tanzania, although only 29% of physicians were familiar with the term “antimicrobial stewardship”. Escherichia coli isolates had resistance rates of over 60% to the commonly used agents ciprofloxacin, trimethoprim-sulfamethoxazole, and ceftriaxone. Thirteen out of 14 community pharmacies offered over-the-counter antibiotics for upper respiratory symptoms. Conclusions: International antimicrobial stewardship collaborations can successfully identify opportunities and needs. Evaluating the team’s efforts to improve patient outcomes will be essential.

scholarly journals Access to hypertension care and services in primary health-care settings in Vietnam: a systematic narrative review of existing literature

2019 ◽  
Vol 12 (1) ◽  
pp. 1610253 ◽  
Author(s):  
Lana Meiqari ◽  
Thi-Phuong-Lan Nguyen ◽  
Dirk Essink ◽  
Marjolein Zweekhorst ◽  
Pamela Wright ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Narrative Review ◽  
Health Care Settings ◽  
Primary Health ◽  
Primary Health Care Settings

Awareness of Antimicrobial Resistance among Primary Health Care Workers in Buyende District, Rural Eastern Uganda

2018 ◽  
Vol 22 (5) ◽  
pp. 1-11 ◽  
Author(s):  
Ahebwa Amelia ◽  
Akol Walter ◽  
Achong Emmanuel ◽  
Mugerwa Timothy ◽  
Nakayenga Aminah ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Antimicrobial Resistance ◽  
Health Care Workers ◽  
Primary Health ◽  
Care Workers ◽  
Eastern Uganda

scholarly journals A 7-year surveillance of the drug resistance in Klebsiella pneumoniae from a primary health care center

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Guogang Li ◽  
Sheng Zhao ◽  
Sipei Wang ◽  
Yingqian Sun ◽  
Yangxiao Zhou ◽  
...  
Keyword(s):  
Health Care ◽  
Drug Resistance ◽  
Primary Health Care ◽  
Klebsiella Pneumoniae ◽  
Care Center ◽  
Urine Samples ◽  
Health Care Center ◽  
Primary Health ◽  
Vitek 2 ◽  
Resistance Rates

Abstract Background The increased prevalence of Klebsiella pneumoniae infections and resistance rates are a current cause for concern. However, data for resistance rates in K. pneumoniae strains from primary hospitals and the resistance distribution among the different isolate sample sources are scarce. Methods All the K. pneumoniae strains were isolated from patients who visited a primary health care center located in Central Zhejiang Province from January 2011 to December 2017. The specimens included blood, sputum, cervical secretions and urine. The species were identified by the Vitek 2 Compact Bacterial Identification and Monitoring System or VITEK-MS and the extended spectrum β-lactamase (ESBL) and drug resistance profiles were identified using the AST-GN13 Gram negative susceptibility card (VITEK-2). The genotype of strains from urine sources was analyzed by detecting TEM and SHV genes. Finally, the drug resistance rates among the isolates from different sample sources were analyzed using the Chi square test with SPSS software. Results A total of 5319 K. pneumoniae strains were isolated in this study. Among the 20 antimicrobial drugs studied, the resistance rates of K. pneumoniae strains varied from 1.4% (ertapenem) to 23.1% (nitrofurantoin). The antibiotic resistance rates varied significantly among the isolate samples sources for all, with the highest rates for all antibiotics except for nitrofurantoin found in urine samples. In addition, the ESBL-positive rate in urine samples was 27.1%, significantly higher than that of cervical secretions (20.2%), blood (16.5%) and sputum (15.2%). Compared to the ESBL-negative strains, higher resistance rates were detected in the ESBL-positive strains. The most common genotype of isolates from urine was SHV (28%, 23/82), following by TEM (14.6%, 12/82). Conclusion The highest resistance rates of K. pneumoniae strains to most antibiotics found in urine samples are partly due to the ESBLs, indicating that a special attention should be paid in the treatment of urinary tract infection.

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