Challenges in Implementing Antimicrobial Stewardship Programmes at Secondary Level Hospitals in India: An Exploratory Study.
Challenges in Implementing Antimicrobial Stewardship Programmes at Secondary Level Hospitals in India: An Exploratory Study.
复制标题
在印度中学医院实施抗菌管理计划的挑战：一项探索性研究。
DOI：
10.3389/fpubh.2020.493904
复制
发表时间：
2020
影响因子：
5.2
通讯作者：
Chandy SJ
中科院分区：
文献类型：
--
作者：
Mathew P;Ranjalkar J;Chandy SJ
导言：在中低收入国家(LMIC)的二级医院实施可持续和有效的抗菌素管理(AMS)计划面临许多挑战。重要的是要了解这些挑战，以便能够根据这些医疗机构提出的独特要求来定制管理倡议。本研究探讨了印度喀拉拉邦二级医院实施AMS的经验。方法：计划一项定性研究，描绘在二级医院实施AMS所面临的挑战。在为期一年的随访期接近尾声时，使用半结构访谈指南对每家医院的节点官员进行了访谈。深度访谈被转录，随后使用N-Vivo 11.0进行内容分析，N-Vivo 11.0是用于定性分析的流行软件工具。结果：许多医生认为患者的满意度是增加抗生素使用的原因之一，因为许多患者认为抗生素是治疗的标准。此外，患者行走的距离和年龄的增加也是增加抗生素使用量的因素。决定使用的医生因素包括经验性的治疗需求、疾病的爆发、缺乏关于抗生素使用的教育计划以填补知识缺口以及对诉讼的恐惧。公司的促销活动和抗生素是小医院的主要收入来源，影响了使用模式。决定抗生素选择的因素包括从众态度、医生的经验、对某些抗生素的抗药性、特定疾病的出现以及与抗菌剂有关的促销活动。实施可持续管理方案的挑战是多方面的。这包括医生之间的竞争，医生面临的时间限制，缺乏冠军，部门间合作不佳，缺乏配套设施，监管系统功能失调，以及抗生素图谱的不可靠。讨论：资源有限的AM将是一个挑战，特别是在融资、获得技术和能力建设方面。应有效地利用国际伙伴关系的政治和监管意志力，为低收入国家制定解决办法。此外，来自其他地方的管理模式在低资源环境下实施之前应该经历一个适应过程。
Introduction: Implementing a sustainable and effective Antimicrobial Stewardship (AMS) programme in secondary level hospitals, in Low-Middle Income Country (LMIC) contexts, has numerous challenges. It is important to understand these challenges so that the stewardship initiatives can be tailored according to the unique requirements thrown up by these healthcare facilities. This study explores the experiences of implementing AMS in secondary level hospitals in the state of Kerala, India. Methods: A qualitative study was planned to map the challenges in implementing AMS in the secondary level hospitals. Toward the end of the 1 year followup period, the nodal officers at each hospital were interviewed using a semi-structured interview guide. The in-depth interviews were transcribed and later subjected to content analysis using N-Vivo 11.0, a popular software tool used for qualitative analysis. Results: Many physicians cite perceived patient satisfaction as one of the reasons for increased antibiotic use, as many patients consider antibiotics as standard of care. Also, the distance traveled by the patient and advancing age are factors which increase antibiotic use. The physician factors which determine use include empiric treatment needs, outbreak of diseases, absence of education programmes in antibiotic usage to fill in the knowledge gap and fear of litigation. The promotional activities by companies and antibiotics being a major source of income for small hospitals, affects use patterns. The factors which determine antibiotic selection includes conformism, experience of the physician, perceived resistance to certain antibiotics, emergence of specific diseases, and promotional activities related to antimicrobial agents. The challenges in implementing a sustainable stewardship programme is multifactorial. It includes competition between doctors, time constraints faced by physicians, absence of a champion, sub-optimal interdepartmental cooperation, absence of supporting facilities, dysfunctional regulatory systems, and unreliability of antibiograms. Discussion: AMS in resource-limited setting is going to be a challenge, especially in terms of financing, access to technologies and capacity building. Political and regulatory willpower of international partnerships should be effectively harnessed for designing solutions for LMIC contexts. Also, models for stewardship from elsewhere should undergo an adaptation process before implementation in low resource settings.
登录
查看更多内容
影响因子：
5.4
作者：
Lee BR;Goldman JL;Yu D;Myers AL;Stach LM;Hedican E;Jackson MA;Newland JG
通讯作者：
Newland JG
影响因子：
5.2
作者：
Klein, Eili Y.;Makowsky, Michael;Laxminarayan, Ramanan
通讯作者：
Laxminarayan, Ramanan
影响因子：
4.8
作者：
Edwards, Suzanne E.;Morel, Chantal M.;Harbarth, Stephan
通讯作者：
Harbarth, Stephan
影响因子：
4.5
作者：
Safdar N;Anderson DJ;Braun BI;Carling P;Cohen S;Donskey C;Drees M;Harris A;Henderson DK;Huang SS;Juthani-Mehta M;Lautenbach E;Linkin DR;Meddings J;Miller LG;Milstone A;Morgan D;Sengupta S;Varman M;Yokoe D;Zerr DM;Research Committee of the Society for Healthcare Epidemiology of America
通讯作者：
Research Committee of the Society for Healthcare Epidemiology of America
影响因子：
5.9
作者：
Bouza, Emilio;Munoz, Patricia;Burillo, Almudena
通讯作者：
Burillo, Almudena