scholarly journals Antimicrobial Stewardship in General Practice: A Scoping Review of the Component Parts

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 498 ◽  
Author(s):  
Lesley Hawes ◽  
Kirsty Buising ◽  
Danielle Mazza
Keyword(s):  
General Practice ◽  
Health System ◽  
Antimicrobial Stewardship ◽  
Scoping Review ◽  
Action Plan ◽  
Information Resources ◽  
Antibiotic Prescribing ◽  
National Action Plan ◽  
The Public

There is no published health-system-wide framework to guide antimicrobial stewardship (AMS) in general practice. The aim of this scoping review was to identify the component parts necessary to inform a framework to guide AMS in general practice. Six databases and nine websites were searched. The sixteen papers included were those that reported on AMS in general practice in a country where antibiotics were available by prescription from a registered provider. Six multidimensional components were identified: 1. Governance, including a national action plan with accountability, prescriber accreditation, and practice level policies. 2. Education of general practitioners (GPs) and the public about AMS and antimicrobial resistance (AMR). 3. Consultation support, including decision support with patient information resources and prescribing guidelines. 4. Pharmacist and nurse involvement. 5. Monitoring of antibiotic prescribing and AMR with feedback to GPs. 6. Research into gaps in AMS and AMR evidence with translation into practice. This framework for AMS in general practice identifies health-system-wide components to support GPs to improve the quality of antibiotic prescribing. It may assist in the development and evaluation of AMS interventions in general practice. It also provides a guide to components for inclusion in reports on AMS interventions.

scholarly journals Feasibility and Validity of a Framework for Antimicrobial Stewardship in General Practice: Key Stakeholder Interviews

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 900
Author(s):  
Lesley A. Hawes ◽  
Jaclyn Bishop ◽  
Kirsty Buising ◽  
Danielle Mazza
Keyword(s):  
General Practice ◽  
Antimicrobial Stewardship ◽  
Antibiotic Prescribing ◽  
Community Based ◽  
The Public ◽  
Professional Groups ◽  
Key Stakeholders ◽  
Secondary Objective ◽  
Further Development

There is little guidance about developing systems for antimicrobial stewardship (AMS) for general practice. A literature review identified six key components: governance, monitoring of antibiotic prescribing and resistance with feedback to prescribers, consultation support, education of the public and general practitioners, pharmacist and nurse involvement, and research, which were incorporated into a potential framework for the general practice context. Objectives: to determine the feasibility and validity of the proposed AMS framework. A secondary objective was to identify likely bodies responsible for implementation in Australia. We undertook interviews with 12 key stakeholders from government, research, and professional groups. Data were analysed with a thematic approach. The framework was considered valid and feasible. No clear organisation was identified to lead AMS implementation in general practice. The current volume-based antibiotic prescription monitoring system was considered insufficient. AMS education for the public, further development of GP education, and improved consultation support were strongly recommended. The role of community-based pharmacists and nurses is largely unexplored, but their involvement was recommended. A clear leader to drive AMS in general practice is essential for an action framework to gain traction. Monitoring and feedback of antibiotic prescribing require urgent development to include monitoring of prescribing appropriateness and patient outcomes.

scholarly journals Albanian National Action Plan for Roma Inclusion 2016–2020: A Study on the Program Achievements at the Halfway Mark

SAGE Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 215824402110361
Author(s):  
Gentian Qejvanaj
Keyword(s):  
Action Plan ◽  
Communist Regime ◽  
Background Information ◽  
Structured Interviews ◽  
National Action Plan ◽  
Current State ◽  
The Us ◽  
Implementation Period ◽  
Education And Employment

Roma segregation in Albania has been causing growing concern since the fall of the communist regime. In this study, we analyze the effectiveness of the Albanian national action plan for Roma inclusion 2016–2020, in 2018, halfway in its implementation period. We gathered data on education and employment from the pre-implementation period (2015) and compared it with the latest available data in 2018. Interviews with local experts and surveys by the Balkan Barometer will provide background information to assess the current state of Roma integration in Albania. Moreover, descriptive statistics from national and international institutions and structured interviews will draw an independent narrative of Roma affairs. In our conclusion, we suggest moving beyond the “us and them” approach with programs run on inertia; our findings highlight that although encouraging achievements have been reached under the 2016–2020 action plan, real inclusion is still far, as statistical achievements do not say much about the quality of the education or job training provided under the 2016–2020 action plan.

scholarly journals Utilizing Behavioral Science to Improve Antibiotic Prescribing in Rural Urgent Care Settings

2020 ◽  
Vol 41 (S1) ◽  
pp. s506-s507
Author(s):  
Patricia Cummings ◽  
Rita Alajajian ◽  
Larissa May ◽  
Russel Grant ◽  
Hailey Greer ◽  
...  
Keyword(s):  
Patient Education ◽  
Influenza Season ◽  
Action Plan ◽  
Inappropriate Prescribing ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Intervention Period ◽  
National Action Plan ◽  
Its Analysis ◽  
Urgent Care Centers

Background: The rate of inappropriate antibiotic prescribing for acute respiratory tract infections (ARTIs) is 45% among urgent care centers across the United States. To contribute to the US National Action Plan for Combating Antibiotic-Resistant Bacteria, which aims to decrease rates of inappropriate prescribing, we implemented 2 behavioral nudges using the evidence-based MITIGATE tool kit from urgent-care settings, at 3 high-volume, rural, urgent-care centers. Methods: An interrupted time series (ITS) analysis was conducted comparing a preintervention phase during the 2017–2018 influenza season (October through March) to the intervention phase during the 2018–2019 influenza season. We compared the rate of inappropriate or non–guideline-concordant antibiotic prescribing for ARTIs across 3 urgent-care locations. The 2 intervention behavioral nudges were (1) staff and patient education and (2) peer comparison. Provider education included presentations at staff meetings and grand rounds, and patient education print materials were distributed to the 3 locations coupled with news media and social media. We utilized the CDC “Be Antibiotics Aware” campaign materials, with our hospital’s logo added, and posted them in patient rooms and waiting areas. For the peer comparison behavioral intervention, providers were sent individual feedback e-mails with their prescribing data during the intervention period and a blinded ranking e-mail in which they were ranked in comparison to their peers. In the blinded ranking email, providers were placed into categories of “low prescribers,” those with a ≤23% inappropriate antibiotic prescribing rate based on the US National Action Plan for Combating Antibiotic-Resistance Bacteria 2020 goal, or “high prescribers,” those with a rate greater than the national average (45%) of inappropriate antibiotic prescribing for ARTI. Results: Our results show that fewer inappropriate antibiotic prescriptions were written during the intervention period (58.8%) than during the preintervention period (73.0%), resulting in a 14.5% absolute decrease in rates of inappropriate prescribing among urgent-care locations over a 6-month period (Fig. 1). The largest percentage decline in rates was seen in the month of April (−35.8%) when compared to April of the previous year. The ITS analysis revealed that the rate of inappropriate prescribing was statistically significantly different during the preintervention period compared to the intervention period (95% CI, −4.59 to −0.59; P = .0142). Conclusions: Using interventions outlined in the MITIGATE tool kit, we were able to reduce inappropriate antibiotic prescribing for ARTI in 3 rural, urgent-care locations.Funding: NoneDisclosures: Larissa May repo, Speaking honoraria-Cepheid Research grants-Roche Consultant-BioRad Advisory Board-Qvella Consultant-Nabriva

scholarly journals Knowledge, Perceptions and Practices of Community Pharmacists Towards Antimicrobial Stewardship: A Systematic Scoping Review

Antibiotics ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 263 ◽  
Author(s):  
Sajal K. Saha ◽  
Chris Barton ◽  
Shukla Promite ◽  
Danielle Mazza
Keyword(s):  
Infection Control ◽  
Patient Care ◽  
Antimicrobial Stewardship ◽  
Scoping Review ◽  
Community Pharmacists ◽  
Antibiotic Use ◽  
Methodological Framework ◽  
Medical Databases ◽  
Further Development

The scope of antimicrobial stewardship (AMS) surveys on community pharmacists (CPs) is uncertain. This study examines the breadth and quality of AMS survey tools measuring the stewardship knowledge, perceptions and practices (KPP) of CPs and analyse survey outcomes. Following PRISMA-ScR checklist and Arksey and O’Malley’s methodological framework seven medical databases were searched. Two reviewers independently screened the literatures, assessed quality of surveys and KPP outcomes were analysed and described. Ten surveys were identified that assessed CPs’ AMS perceptions (n = 7) and practices (n = 8) but none that assessed AMS knowledge. Three survey tools had been formally validated. Most CPs perceived that AMS improved patient care (median 86.0%, IQR, 83.3–93.5%, n = 6), and reduced inappropriate antibiotic use (84.0%, IQR, 83–85%, n = 2). CPs collaborated with prescribers for infection control (54.7%, IQR 34.8–63.2%, n = 4) and for uncertain antibiotic treatment (77.0%, IQR 55.2–77.8%, n = 5). CPs educated patients (53.0%, IQR, 43.2–67.4%, n = 5) and screened guideline-compliance of antimicrobial prescriptions (47.5%, IQR, 25.2–58.3%, n = 3). Guidelines, training, interactions with prescribers, and reimbursement models were major barriers to CP-led AMS implementation. A limited number of validated survey tools are available to assess AMS perceptions and practices of CPs. AMS survey tools require further development to assess stewardship knowledge, stewardship targets, and implementation by CPs.

scholarly journals Attitudes of newly qualified doctors towards a career in general practice: a qualitative focus group study

2017 ◽  
Vol 67 (657) ◽  
pp. e253-e259 ◽  
Author(s):  
Alexandra Merrett ◽  
Daniel Jones ◽  
Kim Sein ◽  
Trish Green ◽  
Una Macleod
Keyword(s):  
Job Satisfaction ◽  
General Practice ◽  
Universal Access ◽  
Focus Group Study ◽  
Skill Levels ◽  
The Public ◽  
Audio Recordings ◽  
The Government ◽  
Training Skill

BackgroundA key element of the NHS is universal access to a GP. Recently, UK general practice has been described as being in crisis, with training places unfilled and multiple practices reporting vacancies or facing closure. The recruitment of GPs continues to be a key focus for both the Royal College of General Practitioners (RCGP) and the government.Aim To understand the attitudes of newly qualified doctors towards a career in general practice, to appreciate potential reasons for the crisis in GP recruitment, and to recommend ways to improve recruitment.Design and setting A qualitative study comprising five focus groups with 74 Foundation Year 1 (FY1) doctors from one Yorkshire deanery.MethodAudio recordings were transcribed verbatim and thematic analysis undertaken.ResultsFoundation Year 1 doctors’ thoughts towards a career in general practice were summarised in four themes: quality of life, job satisfaction, uncertainty surrounding the future of general practice, and the lack of respect for GPs among both doctors and the public. Participants felt that general practice could provide a good work–life balance, fair pay, and job stability. Job satisfaction, with the ability to provide care from the cradle to the grave, and to work within a community, was viewed positively. Uncertainties around future training, skill levels, pay, and workload, together with a perceived stigma experienced in medical schools and hospitals, were viewed as a deterrent to a career in general practice.ConclusionThis study has gathered the opinions of doctors at a critical point in their careers, before they choose a future specialty. Findings highlight areas of concern and potential deterrents to a career in general practice, together with recommendations to address these issues.

Assessing the uptake and effectiveness of a quick reference guide to antibiotic prescribing in Australian general practice

2016 ◽  
Vol 22 (6) ◽  
pp. 565 ◽  
Author(s):  
Angus Thompson ◽  
Patrick O'Sullivan ◽  
Elisabeth Banham ◽  
Greg Peterson
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Antimicrobial Stewardship ◽  
Antibiotic Prescribing ◽  
Duration Of Treatment ◽  
Reference Guide ◽  
Treatment Dose ◽  
Dosing Frequency ◽  
Australian General Practice ◽  
Prescribing Practice

Prescribing guidelines are an essential component of antimicrobial stewardship programs in Australian hospitals. Nonetheless, the majority of antibiotic prescribing occurs in the community and the effectiveness of guidelines developed specifically to meet the needs of Australian general practice is unknown. This study aims to assess the uptake and effectiveness of a quick reference guide to antibiotic prescribing among primary care prescribers. A quick reference guide to antibiotic prescribing was developed and prescribers in five Tasmanian practices were surveyed regarding use of this guide. Thirty-three surveys were returned and, of those answering specific sections, 75% were aware of the guide and 71% had used it within the last month. The guide affected the antibiotic prescribing practice of 74% of responding prescribers; most often on choice of antibiotic; but also on duration of treatment, dose and dosing frequency. A quick reference guide to antibiotic prescribing was well received by prescribers and may usefully support efforts to improve antimicrobial stewardship in the community.

scholarly journals Patient Safety and Clinical Risk Management for General Practice

2020 ◽  
Vol 1 (2) ◽  
pp. 1-5
Author(s):  
Lucio Mango
Keyword(s):  
Risk Management ◽  
General Practice ◽  
Patient Safety ◽  
Health System ◽  
General Practitioners ◽  
Clinical Risk Management ◽  
Causal Factors ◽  
The Family ◽  
First Contact

General practitioners are the first contact between the person, the family and the community with the health system. The philosopher and epistemologist K. Popper (1902-1994) recommended the need to register errors, in order to know them, catalog them and therefore prevent them. J.Reason in 1963 introduced the systemic approach to the study of errors with the theory of latent errors. The knowledge of the causal factors, or which in any case contribute, of possible errors, as well as of the latent gaps in the system, is a fundamental prerequisite for the construction of paths aimed at improving the quality of assistance, structures and organizational aspects.

scholarly journals Breast cancer screening in Brazil. Barriers related to the health system

2017 ◽  
Vol 63 (5) ◽  
pp. 466-474 ◽  
Author(s):  
René Aloisio da Costa Vieira ◽  
Alessandro Formenton ◽  
Silvia Regina Bertolini
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Health System ◽  
Breast Cancer Screening ◽  
Diagnosis And Treatment ◽  
Stage At Diagnosis ◽  
The Public ◽  
Effective Order ◽  
Study Results

Summary Objective: Identify factors related to the health system that lead to a late diagnosis of breast cancer in Brazil. Method: We performed a systematic review in the PubMed and LILACS databases using as keywords "Breast cancer," "system of health" and "Brazil or Brasil." We evaluated the content of the articles using the PRISMA methodology based on PICTOS. The final date was 12/16/2015. We were able to identify 94 publications in PubMed and 43 publications in LILACS. After assessing the title and summary, and excluding 21 repeated publications, we selected 51 publications for full evaluation. At this stage, we excluded 21 articles, with 30 publications remaining for study. Results: The population coverage is low, and there are problems related to the quality of mammography. Patients with lower income, nonwhite and less educated are more vulnerable. We observed punctual and initial experiences in breast cancer screening. Diagnosis and treatment flows must be improved. The inequality in mortality reflects the differences related to screening structure and treatment. Better results are observed in well-structured services. Conclusion: There are several barriers in the health system leading to advanced stage at diagnosis and limiting the survival outcomes. The establishment of a rapid and effective order for diagnosis and treatment, based on hierarchical flow, are important steps to be improved in the public health context.

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