scholarly journals Perceptions, Current Practices and Interventions of Community Pharmacists Regarding Antimicrobial Stewardship: A Qualitative Study in France

2021 ◽  
Author(s):  
Claire Durand ◽  
Aude Chappuis ◽  
Eric Douriez ◽  
Frédérique Poulain ◽  
Raheelah Ahmad ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Antimicrobial Resistance ◽  
Community Health ◽  
Antimicrobial Stewardship ◽  
Thematic Analysis ◽  
Community Pharmacists ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Community Health Care

Abstract Background: Community health care accounts for the vast majority of antibiotic use in Europe. Given the threat of antimicrobial resistance (AMR), there is an urgent need to develop new antimicrobial stewardship (AMS) interventions in primary care that could involve different health care providers including community pharmacists. This study aimed to explore the perceptions, currents practices and interventions of community pharmacists regarding antimicrobial stewardship.Methods: Semi-structured qualitative interviews were conducted with community pharmacists in France. Participants were recruited through a professional organization of community pharmacists combined with a snowballing technique. Interviews were audio recorded, transcribed and analyzed using thematic analysis. The Consolidated Framework for Implementation Research was used while developing the interview guide and carrying out thematic analysis.Results: Sixteen community pharmacists participated. All the respondents had good awareness about antimicrobial resistance and believed community pharmacists had an important role in tackling AMR. Some barriers to community pharmacists’ participation in AMS were identified such as difficult interactions with prescribers, lack of time and lack of access to patient medical records and diagnosis. Increased patient education, audits and feedback of antibiotic prescribing, increased point-of-care testing and delayed prescribing were interventions suggested by the pharmacists to improve antibiotic use in primary care. Strategies cited by participants to facilitate the implementation of such interventions are increased pharmacist-general practitioner collaboration, specialized training, clinical decision support tools as well as financial incentives. Conclusions: This study suggests that community pharmacists could play a greater role in infection management and AMS interventions. Further interprofessional collaboration is needed to optimize antibiotic prescribing and utilization in community health care.

scholarly journals The Use of a Family History Risk Assessment Tool within a Community Health Care System: Views of Primary Care Providers

2012 ◽  
Vol 21 (5) ◽  
pp. 652-661 ◽  
Author(s):  
Carol A. Christianson ◽  
◽  
Karen Potter Powell ◽  
Susan Estabrooks Hahn ◽  
Susan H. Blanton ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Health Care ◽  
Family History ◽  
Community Health ◽  
Assessment Tool ◽  
Primary Care Providers ◽  
Community Health Care ◽  
Care Providers ◽  
Community Health Care System

scholarly journals Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 196
Author(s):  
Alma C. van de Pol ◽  
Josi A. Boeijen ◽  
Roderick P. Venekamp ◽  
Tamara Platteel ◽  
Roger A. M. J. Damoiseaux ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Primary Care ◽  
Health Care ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Skin Infections ◽  
Prescription Rates ◽  
Ear Infections ◽  
Disease Entities

In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners’ Network were followed from March through May 2019 (n = 389,708) and March through May 2020 (n = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54; confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71; CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54; CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference −8.0% (CI, −8.8 to −7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15–19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications.

scholarly journals A pragmatic randomized trial of a primary care antimicrobial stewardship intervention in Ontario, Canada

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Warren McIsaac ◽  
Sahana Kukan ◽  
Ella Huszti ◽  
Leah Szadkowski ◽  
Braden O’Neill ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Care Provider ◽  
Primary Care Provider ◽  
Antibiotic Use ◽  
Primary Care Providers ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Tract Infections

Abstract Background More than 90% of antibiotics are prescribed in primary care, but 50% may be unnecessary. Reducing unnecessary antibiotic overuse is needed to limit antimicrobial resistance. We conducted a pragmatic trial of a primary care provider-focused antimicrobial stewardship intervention to reduce antibiotic prescriptions in primary care. Methods Primary care practitioners from six primary care clinics in Toronto, Ontario were assigned to intervention or control groups to evaluate the effectiveness of a multi-faceted intervention for reducing antibiotic prescriptions to adults with respiratory and urinary tract infections. The intervention included provider education, clinical decision aids, and audit and feedback of antibiotic prescribing. The primary outcome was total antibiotic prescriptions for these infections. Secondary outcomes were delayed prescriptions, prescriptions longer than 7 days, recommended antibiotic use, and outcomes for individual infections. Generalized estimating equations were used to estimate treatment effects, adjusting for clustering by clinic and baseline differences. Results There were 1682 encounters involving 54 primary care providers from January until May 31, 2019. In intervention clinics, the odds of any antibiotic prescription was reduced 22% (adjusted Odds Ratio (OR) = 0.78; 95% Confidence Interval (CI) = 0.64.0.96). The odds that a delay in filling a prescription was recommended was increased (adjusted OR=2.29; 95% CI=1.37, 3.83), while prescription durations greater than 7 days were reduced (adjusted OR=0.24; 95% CI=0.13, 0.43). Recommended antibiotic use was similar in control (85.4%) and intervention clinics (91.8%, p=0.37). Conclusions A community-based, primary care provider-focused antimicrobial stewardship intervention was associated with a reduced likelihood of antibiotic prescriptions for respiratory and urinary infections, an increase in delayed prescriptions, and reduced prescription durations. Trial registration clinicaltrials.gov (NCT03517215).

Clinical governance in community health care settings: Evidence and issues

2005 ◽  
Vol 11 (2) ◽  
pp. 26 ◽  
Author(s):  
Hal Swerissen ◽  
Lucinda Jordan
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Community Health ◽  
Clinical Governance ◽  
Community Health Service ◽  
Community Health Care ◽  
Health Care Settings ◽  
Governance Framework ◽  
Suitable Framework

This paper identifies clinical governance frameworks within the literature that are applicable to community health care settings. The paper focuses on three main topics: the importance of developing a clinical governance framework within a community health service; the main elements of a clinical governance framework; and the process of implementing a suitable framework. Although research for primary care is more limited, the available evidence suggests that, as with hospitals, there are significant opportunities for improving the safety and quality of clinical practice in primary care through improved clinical governance. Frameworks for clinical governance, key elements for implementation, and methods of implementation are also identified.

scholarly journals 2071. A Survey of Antibiotic Prescribing Practices Among Adult Primary Care Physicians in Idaho

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S698-S698
Author(s):  
Anubhav Kanwar ◽  
Susan Heppler ◽  
Karl Madaras-Kelly ◽  
Martha Jaworski ◽  
Curtis Donskey
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Primary Care Physicians ◽  
Healthcare Facility ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescription Data ◽  
Prescribing Practices ◽  
Diagnostic Uncertainty ◽  
Test Ordering

Abstract Background Prescribing an antibiotic is a complex process involving an interplay of prescriber’s knowledge, diagnostic acumen and patient factors. Understanding the prescriber rationale is key to provide feedback which might improve appropriateness of antibiotic prescribing. Currently, there are limited data on prescribing and test ordering practices among primary care physicians. Methods We surveyed primary care physicians taking care of adults (age 18 years and above). Physicians were contacted through the Idaho State Medical Board by a one-time email containing the survey link. The survey consisted of 25 questions under 2 major themes of diagnostic and antimicrobial stewardship (AS). It assessed physicians’ practice setting, ordering of diagnostic tests and antibiotics for common infections, delivery of patient education regarding antibiotics, availability of antibiogram and antimicrobial stewardship services, and assessment of penicillin allergy. Two infectious diseases physicians independently reviewed the results for appropriateness of testing and antibiotic prescribing per IDSA guidelines. Results Of 929 physicians surveyed, 157 (17%) responded. Of the respondents, 95 (61%) were male, the mean age was 50 years, and 72% worked in outpatient settings and were family medicine specialists. Only 55% of physicians reported having an AS program at their healthcare facility. Test-of-cure for C. difficile infection (24%) and UTI (13%) and use of superficial culture data to guide the treatment of osteomyelitis (27%) were the most common reasons for inappropriate testing. Longer than recommended duration, antibiotic combinations with overlap of spectrum, and guideline-discordant indications for prescribing antibiotics were the main reasons for inappropriate antibiotic use. The main factors influencing the decision to prescribe an antibiotic were diagnostic uncertainty (42%), being unsure of patient follow-up (23%) and cost of testing (21%). Conclusion The survey results highlight the need for prescriber education for decreasing inappropriate test ordering and antibiotic prescribing. Additional studies involving a review of patient records, lab and prescription data are needed to confirm these practices. Disclosures All authors: No reported disclosures.

scholarly journals Knowledge and Practice of Pharmacists toward Antimicrobial Stewardship in Pakistan

Pharmacy ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 116 ◽  
Author(s):  
Inayat Rehman ◽  
Malik Asad ◽  
Allah Bukhsh ◽  
Zahid Ali ◽  
Humera Ata ◽  
...  
Keyword(s):  
Health Care ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Health Care Professionals ◽  
Improve Patient Care ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Healthcare Settings ◽  
Knowledge And Practice

Background: The irrational use, “over the counter supply”, and unregulated supply chains of antimicrobials are contributing toward antimicrobial resistance. Antimicrobial stewardship programs regulate antimicrobials usage to prevent resistance and reduce health care burden. Objective: To assess the knowledge and practice of pharmacists’ working in various healthcare settings toward antimicrobial stewardship in Pakistan. Method: A cross-sectional study was conducted among pharmacists working in different sectors between March to June 2017. Results: A total of 181 pharmacists participated, of whom (n = 145, 80.1%) were males. The majority of participants were in the 20–30 age group (n = 147, 81.2%) and hold Doctor of Pharmacy degrees. More than 80% of pharmacists agreed that “antimicrobial stewardship is essential to improve patient care”; while (n = 159, 87.8%) pharmacists agreed that “pharmacist should be trained on the use of antimicrobial”. Close to 90% of pharmacists agreed that “adequate training should be provided to pharmacists on antimicrobial use”. Regarding the practice of antimicrobial stewardship, (n = 72, 39.8%) pharmacists often/always “make efforts to prevent or reduce the transmission of infections within the community”; (n = 58, 32%) pharmacists never “dispense antimicrobials without a prescription”; and (n = 60, 32%) pharmacist often/always “communicate with prescribers if unsure about the appropriateness of an antibiotic prescription”. Conclusions: Increased antimicrobial stewardship efforts can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. Pharmacists in Pakistan have good knowledge and adopt positive practices toward antimicrobial stewardship. Pharmacist and other health care professionals should collaborate within multi-disciplinary teams to reduce the problem of antimicrobial resistance and improve the quality of life of patients.

scholarly journals Prescriber-led practice changes that can bolster antimicrobial stewardship in community health care settings

2020 ◽  
Vol 46 (01) ◽  
pp. 1-5
Author(s):  
Jerome A Leis ◽  
Karen B Born ◽  
Olivia Ostrow ◽  
Andrea Moser ◽  
Allan Grill
Keyword(s):  
Health Care ◽  
Community Health ◽  
Antimicrobial Stewardship ◽  
Community Health Care ◽  
Health Care Settings
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