scholarly journals Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1441
Author(s):  
Lok Hang Wong ◽  
Evonne Tay ◽  
Shi Thong Heng ◽  
Huiling Guo ◽  
Andrea Lay Hoon Kwa ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Ecological Model ◽  
Public Awareness ◽  
Antibiotic Use ◽  
Public Hospitals ◽  
Group Discussions ◽  
Hospital Pharmacists ◽  
The Social ◽  
Facilitators And Barriers ◽  
Interpersonal Level

Antimicrobial stewardship programmes (ASPs) in hospitals are predominantly led by specific ASP physicians and pharmacists. Limited studies have been conducted to appreciate non-ASP-trained hospital pharmacists’ perspectives on their roles in antimicrobial stewardship. Focus group discussions (FGDs) were conducted with 74 pharmacists, purposively sampled from the 3 largest acute-care public hospitals in Singapore, to explore facilitators and barriers faced by them in antimicrobial stewardship. Applied thematic analysis was conducted and codes were categorised using the social–ecological model (SEM). At the intrapersonal level, pharmacists identified themselves as reviewers for drug safety before dispensing, confining to a restricted advisory role due to lack of clinical knowledge, experience, and empowerment to contribute actively to physicians’ prescribing decisions. At the interpersonal level, pharmacists expressed difficulties conveying their opinions and recommendations on antibiotic therapy to physicians despite frequent communications, but they assumed critical roles as educators for patients and their caregivers on proper antibiotic use. At the organisational level, in-house antibiotic guidelines supported pharmacists’ antibiotic interventions and recommendations. At the community level, pharmacists were motivated to improve low public awareness and knowledge on antibiotic use and antimicrobial resistance. These findings provide important insights into the gaps to be addressed in order to harness the untapped potential of hospital pharmacists and fully engage them in antimicrobial stewardship.

scholarly journals “Whose Fault Is It?” How Rural Chinese Women Explain Intimate Partner Violence: A Qualitative Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Fengsu Hou ◽  
Catherine Cerulli ◽  
Marsha N. Wittink ◽  
Eric D. Caine ◽  
Peiyuan Qiu
Keyword(s):  
Intimate Partner Violence ◽  
Partner Violence ◽  
Ecological Model ◽  
Migrant Worker ◽  
Chinese Women ◽  
Public Awareness ◽  
Qualitative Interviews ◽  
Intimate Partner ◽  
Social Characteristics ◽  
The Social

Women are often the victims of intimate partner violence (IPV). Though China has established its first statute against domestic violence, the service developments for victims fall behind. It is important to assess community members' perceptions of what causes IPV to create interventions to prevent and address IPV. This study completed the Short Explanatory Model Interview (SEMI) among a subset sample from a large epidemiology study in rural Sichuan China. The social ecological model was applied to analyze qualitative interviews. Among 339 participants, the average age was 46.01 ± 12.42 years old. There were 31.86% of them had been educated, 14.75% of them had migrant worker partners, and 49.26% of them had experienced violence from their partners in the last year. There were 252 participants attributed IPV to individual factors, and they primarily discussed the social characteristics, behaviors, personalities or even health problems of the husband or the wife in the vignette. Under this theme, there were 86 participants blaming the victim for being anxious, social disconnectedness or lazy; and there were 166 participants blaming to the perpetrator being abusive, irresponsibility, lack of understanding, and cheating. There were 44 women believed the cause was relational, in which there were 41 participants attributed the problem to the broken relationship between the couple and three participants attributed to the lack of support. There were 28 participants believed the cause was communal and societal, such as being poor, family problems, fate, and believed IPV was a common scene. There were 15 participants could not identify the cause of IPV. These participants usually provided very brief responses and barely had insight on violent behaviors or confidence in discussing the cause. Our findings offer a direction for understanding the rural Chinese women's beliefs about the etiology of IPV to better develop interventions which must consider raising a public awareness campaign about the risk factors of IPV and focus on reducing self-blame among victims.

scholarly journals COMMUNITY MOVEMENT IN WASTE MANAGEMENT (Case in Cikapundung River Basin in Bandung City)

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Bintarsih Sekarningrum ◽  
Desi Yunita
Keyword(s):  
Waste Management ◽  
Community Organizing ◽  
Qualitative Method ◽  
Public Awareness ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
The People ◽  
The Social ◽  
The Government ◽  
Community Movement

There is a connection between the behaviour of throwing waste into the river with the community perspective about river. The behaviour of people throwing waste into the river assosiated with the lack of availability of facilities dispose of waste in the area and looked at the river as an object or place that is easiest to throw garbage into the river. Related to these problems, this research describes the community who doing the social movement in waste management a long the river, as well as analyzing patterns of community organizing in waste management.The approach used is a qualitative method of data collection techniques consisted of observation, interviews and focus group discussions. Research shows that the government has made efforts through the program "Clean Cikapundung River", and waste management efforts, sediment transport and manufacture kirmir on a riverbank to prevent abrasion. However Cikapundung still dirty and full of trash. To overcome these problems, there are many communities who awakened and stirred to make an effort in order Cikapundung no longer become dumping grounds. The movement to strive for existence of the river can be used again as an important source of livelihood for the people. Community was formed to instill public awareness of the environment, especially rivers, in the form of an appeal and a call to people not to throw garbage into the river and do the cleaning and arrangement along the river so that the river Cikapundung clean and free of trash based on solidarity and mutual assistance. The social movements showed public awareness to make changes to their environment, especially the problem of waste in the river.

scholarly journals Facilitators and barriers to physicians’ entrepreneurial ventures in major Japanese cities: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258957
Author(s):  
Daichi Yashiro ◽  
Nobutoshi Nawa ◽  
Eriko Okada ◽  
Hiroaki Kato ◽  
Sarara Yonemori-Matsumoto ◽  
...  
Keyword(s):  
Medical Students ◽  
Financial Stability ◽  
Ecological Model ◽  
Qualitative Interviews ◽  
Group Discussions ◽  
Entrepreneurial Ventures ◽  
New Business ◽  
Facilitators And Barriers ◽  
Medical License ◽  
Tokyo Medical

Background The Japanese healthcare system currently faces numerous challenges, including a super-aging society and an excessive burden on medical workers; therefore, the need for innovative solutions from healthcare ventures to tackle these issues has increased. Meanwhile, as physicians play important roles in healthcare ventures, the need for Japanese physician entrepreneurs is more important than ever. Given the lack of research examining barriers to physicians starting ventures and what skills, knowledge, and surrounding environments act as facilitators, this study aimed to identify the facilitators and barriers faced by physicians to start ventures. Methods Between September and November 2019 and in May 2021, qualitative interviews were conducted with 33 participants, which included eight physician entrepreneurs; two administrative officers at the Ministry of Health, Labour and Welfare and the Ministry of Economy, Trade and Industry; three faculty members at Tokyo Medical and Dental University (in-depth interviews); and 20 medical students (focus group discussions). The interviews were deductively coded based on the social ecological model. The inductive approach was applied to coding any knowledge necessary to start a business. We conducted member checking with three physician entrepreneurs and seven medical students to improve our results’ credibility. Results The factors influencing a physician’s decision to launch a new business include their willingness to contribute to society, the unique environment in which an individual is placed while in medical school and afterward, negative aspects of the lack of diversity in physicians’ careers, the financial stability provided by a medical license, and self-efficacy. Conclusions Our study revealed facilitators and barriers to physicians’ entrepreneurial ventures. Knowledge about these factors might be useful in supporting physicians to launch or become involved in healthcare ventures.

scholarly journals Antibiotic prescription in primary care from the perspective of family physicians: a qualitative study

2021 ◽  
Vol 15 (08) ◽  
pp. 1117-1123
Author(s):  
Salih Hosoglu ◽  
Annika Yanina Classen ◽  
Zekeriya Akturk
Keyword(s):  
Primary Care ◽  
Social Status ◽  
Antibiotic Prescription ◽  
Public Awareness ◽  
Family Physicians ◽  
Antibiotic Use ◽  
Patient Expectations ◽  
Medical Decision ◽  
Antibiotic Prescribing ◽  
The Social

Introduction: Antibiotic consumption increases worldwide steadily. Turkey is now top on the list of global consumption and became a prototype of excessive use of antibiotics. In the last two decades, family physicians (FPs) have become key figures in the healthcare system. This study aims to understand the reasons for inappropriate antibiotic prescribing and elicit suggestions for improving antibiotic use in primary care from doctors themselves. Methodology: This is a qualitative semi-structured interview study with research dialogues guided by the Vancouver School of interpretive phenomenology. Fourteen FPs from different parts of Turkey were questioned on inappropriate antibiotic prescriptions and their suggestions for improving antibiotic use. Results: The most important reasons for prescribing antibiotics without acceptable indications were patient expectations, defensive medical decision making, constraints due to workload, and limited access to laboratories. The most remarkable inference was the personal feeling of an insecure job environment of the FPs. The most potent suggestions for improving the quality of antibiotic prescription were public campaigns, improvements in the diagnostic infrastructures of primary care centers, and enhancing the social status of FPs. The FPs expressed strong concerns related to the complaints that patients make to administrative bodies. Conclusions: Primary care physicians work under immense pressure, stemming mainly from workload, patient expectations, and obstacles related to diagnostic processes. Improving the social status of physicians, increasing public awareness, and the facilitation of diagnostic procedures was the methods suggested for increasing antibiotic prescription accuracy.

scholarly journals 2097. Antimicrobial Stewardship Programs in Missouri Hospitals: Facilitators, Barriers, and Complexity of Implementation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S709-S709
Author(s):  
Sena Sayood ◽  
Kevin Hseuh ◽  
Jason Newland ◽  
Hilary Babcock ◽  
David K Warren ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Joint Commission ◽  
State Law ◽  
Implementation Barriers ◽  
Program Complexity ◽  
Core Elements ◽  
Barriers To Implementation ◽  
Facilitators And Barriers ◽  
The Joint Commission

Abstract Background Antibiotic stewardship programs (ASPs) in acute care hospitals reduce unnecessary antibiotic use and attendant complications. In the state of Missouri, all hospitals are required to have an ASP. Additionally, the Joint Commission mandates ASP implementation for accreditation based on core elements defined by the Centers for Disease Control (CDC). No studies have evaluated the uptake of ASP since the Missouri state law and Joint Commission mandate. Furthermore, data are limited examining barriers to implementation across hospitals with variable resources. We evaluated ASP uptake across Missouri hospitals, assessed differences in program complexity, and identified facilitators and barriers to implementation. Methods A 94-question survey was administered electronically in the spring of 2019 to 130 Missouri hospitals. Information was collected regarding implementation details of CDC-defined ASP core elements and tools used to overcome implementation barriers. Results were self-reported by the stewardship pharmacist, the director of pharmacy, or the person most familiar with antimicrobial stewardship if the former were not available. Results Preliminary results have been collected from 37 hospitals ranging in size from 15 to 1303 beds (IQR: 54, 274). 16% were critical access hospitals. 54% of hospitals had ASPs adherent to all 7 CDC core elements. Another 27% had implemented 6 of the core elements, with all of those reporting that they lacked a single pharmacist leader. All facilities had implemented at least some measures to improve antibiotic use, ranging from 4 to 13 measures. 45% of programs used state-based antimicrobial stewardship collaboratives, and 52% of those found such programs to be “very” or “extremely” useful. Conclusion All hospitals surveyed are performing ASP activities in concordance with Missouri state law. However, only half contain the 7 core elements required by the Joint Commission. Furthermore, ASP implementation and activities vary widely. While physician leadership was commonly defined, appropriate pharmacist support was frequently lacking. State-based collaboratives are the most widely used resource, and at least half who use them find them to be helpful. Disclosures All authors: No reported disclosures.

scholarly journals Challenges Experienced by HIV/AIDS-Positive Women in Marital Relationships; A qualitative study

2020 ◽  
Author(s):  
Ahmad Kalateh Sadati ◽  
Vajihe Taheri ◽  
Soroor Hemmati
Keyword(s):  
Data Analysis ◽  
Qualitative Study ◽  
Social Stigma ◽  
Public Awareness ◽  
Marital Relationships ◽  
Sexual Relationships ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
The Social ◽  
Hiv Aids

Introduction: The prevalence of HIV/AIDS is alarmingly increasing. Considering the experiences of HIV/AIDS-positive patients, experiences of the women who took HIV/AIDS from their husbands –marital relationships- can be different. The purpose of this study was to describe the challenges of these women. Methods: This qualitative study was conducted using focus group discussions with 10 women who took HIV/AIDS from their husbands. All interviews were recorded, transcribed verbatim, and analyzed by thematic analysis. Results: Data analysis showed that participants experienced a kind of compulsive social isolation. They could not interact with anyone except their parents. They suffered from social stigma because the disease is associated with the illicit sex label. From data analysis, three main themes of fear, marital despondency, and stigma emerged. Conclusion: The concerns and challenges of women who took HIV/AIDS from their marital relationships revealed that these women were exposed to the social strains because of having HIV / AIDS and stigma of illegitimate sexual relationships. In this regard, public awareness should be raised about this disadvantaged group of the community. To hit this target, individuals should be provided with the required information through schools as well as broadcasting and social media. Implementation of the counseling visits can create  psychological and social support for these traumatized group and their families.

scholarly journals Point-Prevalence Surveys of Antibiotic Use at Three Large Public Hospitals in Kenya

2020 ◽  
Vol 41 (S1) ◽  
pp. s353-s354
Author(s):  
Sylvia Omulo ◽  
Margaret Oluka ◽  
Loice Ombajo ◽  
Eric Osoro ◽  
Rosaline Kinuthia ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Medical Officer ◽  
Antibiotic Use ◽  
Public Hospitals ◽  
Point Prevalence ◽  
Infection Prevention And Control ◽  
Older Individuals ◽  
And Control

Background: Antibiotics are the most prescribed medicines worldwide, accounting for 20%–30% of total drug expenditures in most settings. Antimicrobial stewardship activities can provide guidance for the most appropriate antibiotic use. Objective: In an effort to generate baseline data to guide antimicrobial stewardship recommendations, we conducted point-prevalence surveys at 3 hospitals in Kenya. Methods: Sites included referral hospitals located in Nairobi (2,000 beds), Eldoret (900 beds) and Mombasa (700 beds). [Results are presented in this order.] Hospital administrators, heads of infection prevention and control units, and laboratory department heads were interviewed about ongoing antimicrobial stewardship activities, existing infection prevention and control programs, and microbiology diagnostic capacities. Patient-level data were collected by a clinical or medical officer and a pharmacist. A subset of randomly selected, consenting hospital patients was enrolled, and data were abstracted from their medical records, treatment sheets, and nursing notes using a modified WHO point-prevalence survey form. Results: Overall, 1,071 consenting patients were surveyed from the 3 hospitals (n = 579, n = 263, and n = 229, respectively) of whom >60% were aged >18 years and 53% were female. Overall, 489 of 1,071 of patients (46%) received ≥1 antibiotic, of whom 254 of 489 (52%) received 1 antibiotic, 201 of 489 (41%) received 2 antibiotics, 31 of 489 (6%) received 3 antibiotics, and 3 of 489 (1%) received 4 antibiotics. Antibiotic use was higher among those aged <5 years: 150 of 244 (62%) compared with older individuals (337 of 822, 41%). Amoxicillin/clavulanate was the most commonly used antibiotic (66 of 387, 17%) at the largest hospital (in Nairobi) whereas ceftriaxone was the most common at the other 2 facilities: 57 of 184 (31%) in Eldoret and 55 of 190 (29%) in Mombasa. Metronidazole was the next most commonly prescribed antibiotic (15%–19%). Meropenem was the only carbapenem reported: 22 of 387 patients (6%) in Nairobi, 2 of 190 patients (1%) in Eldoret, and 8 of 184 patients (4%) in Mombasa. Stop dates or review dates were not indicated for 106 of 390 patients (27%) in Nairobi, 75 of 190 patients (40%) in Eldoret, and 113 of 184 patients (72%) in Mombasa receiving antibiotics. Of 761 antibiotic prescriptions, 45% had a least 1 missed dose. Culture and antibiotic susceptibility tests were limited to 50 of 246 patients (20%) in Nairobi, 17 of 124 patients (14%) in Eldoret, and 23 of 119 patients (19%) in Mombasa who received antibiotics. The largest hospital had an administratively recognized antimicrobial stewardship committee. Conclusions: The prevalence of antibiotic use found by our study was 46%, generally lower than the rates reported in 3 similar studies from other African countries, which ranged from 56% to 65%. However, these survey findings indicate that ample opportunities exist for improving antimicrobial stewardship efforts in Kenya considering the high usage of empiric therapy and low microbiologic diagnostic utilization.Funding: NoneDisclosures: None

PP207 Evaluation On Effects Of Antimicrobial Stewardship In Tertiary Comprehensive Public Hospitals in Hainan, China

2019 ◽  
Vol 35 (S1) ◽  
pp. 74-74
Author(s):  
Hong Zhou
Keyword(s):  
Antimicrobial Stewardship ◽  
Emergency Departments ◽  
Outpatient Care ◽  
National Level ◽  
Antibiotic Use ◽  
Public Hospitals ◽  
Antibiotics Resistance ◽  
Type I ◽  
Total Cost ◽  
Rational Use

IntroductionThe National Health Commission issued a special task force on antimicrobial stewardship (AMS). We assess the effects of AMS from 2012 to 2016 in four tertiary comprehensive hospitals in Hainan Province, China, to explore the achievement of AMS to facilitate rational use, to control antimicrobial resistance (AMR), to ensure safety and quality of care.MethodsData from Hospital Information System (HIS) of hospitals according to the criteria of AMS were analyzed. Microsoft Excel data entry and SAS version 9.3 was used for analysis.ResultsThe indicators were general compliance to the national criteria from 2012 to 2016. The percentage of following results in hospitals were gradually reduced: the proportion of antibiotic use in outpatient care (11.09 to 3.25 percent); that in emergency departments (8.46 to 1.53 percent); antibiotics use rate of inpatient care (9.13 to 3.12 percent); antibiotics prophylactic use in type I surgical sites (24.19 to 3.38 percent); the proportion of drug cost (5.54 to 0.12 percent) and total cost of antibiotics (3.27 to 0.45 percent); total cost of antibiotics in outpatient care and emergency departments, which was below 10 percent. Pathogenic detection rate of antibiotics from 2013 to 2016 in three hospitals was increased from 38.75 to 59.6 percent. Hainan Provincial Antibiotics Resistance Monitoring Network conscientiously performs duties, several important and special detection rates of AMR close to the average national level, which have been effectively controlled.ConclusionsIt is needed to continue AMS and to enhance the capacity of rational use of antibiotics by medical professionals. Information systems need to be developed, coordinated and correlated to monitor the consumption of antibiotic use, surveillance of AMR and control of hospital infection.

scholarly journals Public Hospital Pharmacists’ Perceptions and Knowledge of Antibiotic Use and Resistance: A Multicenter Survey

Antibiotics ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 311 ◽  
Author(s):  
Kai Lun Tang ◽  
Tsyr Fen Teoh ◽  
Theng Theng Ooi ◽  
Wei Ping Khor ◽  
Sook Yee Ong ◽  
...  
Keyword(s):  
Public Hospital ◽  
Antibiotic Use ◽  
Shared Responsibility ◽  
Public Hospitals ◽  
Cross Sectional Survey ◽  
Hospital Pharmacists ◽  
Medication Therapy ◽  
Validated Questionnaire ◽  
Stewardship Program ◽  
Multicenter Survey

Antimicrobial Stewardship Program (ASP) has been implemented in major public hospitals in Malaysia, with pharmacists playing a key role in ensuring the appropriate use of antibiotics. This survey aimed to assess the practices, perceptions, and knowledge of public hospital pharmacists on antibiotic use and resistance. A cross-sectional survey involving pharmacists from six public hospitals in Penang was conducted using a self-administered validated questionnaire. The majority of pharmacists perceived that polypharmacy (92%, n = 270) and overuse of broad-spectrum antibiotics (85%, n = 252) can potentially induce resistance of microorganisms and that ensuring the rational use of antibiotics is a shared responsibility between clinicians and pharmacists (94%, n = 278). A large majority of the pharmacists think that formal training in infectious disease should be a pre-requisite for pharmacists in ASP (93%, n = 273). In terms of antibiotic selection, the availability of antibiotics in hospital (81%, n = 234) and patient’s clinical condition (68%, n = 196) are more of a concern to the pharmacists. A total of 65% of the respondents (n = 192) demonstrated good levels of knowledge with a mean knowledge score of 10.1 out of 13 (95% CI: 9.95; 10.31). Pharmacists from the managerial level, ward pharmacy, in-patient, and medication therapy adherence clinic (MTAC) unit had better knowledge of antibiotics compared to pharmacists from other units (p < 0.001). Antibiotic knowledge gap had been identified among pharmacists in different work settings, and longer years of service does not warrant good antibiotic knowledge.

scholarly journals 229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Julia Sessa ◽  
Helen Jacoby ◽  
Bruce Blain ◽  
Lisa Avery
Keyword(s):  
Patient Care ◽  
Teaching Hospital ◽  
Antimicrobial Stewardship ◽  
Rank Order ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

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