Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: findings from a multi-site qualitative study.
Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: findings from a multi-site qualitative study.
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DOI：
10.1186/s13756-021-00929-4
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发表时间：
2021-03-25
影响因子：
5.5
通讯作者：
Tillekeratne LG
中科院分区：
文献类型：
--
作者：
Rolfe R Jr;Kwobah C;Muro F;Ruwanpathirana A;Lyamuya F;Bodinayake C;Nagahawatte A;Piyasiri B;Sheng T;Bollinger J;Zhang C;Ostbye T;Ali S;Drew R;Kussin P;Anderson DJ;Woods CW;Watt MH;Mmbaga BT;Tillekeratne LG
抗菌素耐药性已被列为全球十大公共卫生威胁之一。以医院为基础的抗菌药物管理计划(ASP)可以帮助降低抗菌素耐药性。这项研究的目的是确定在三个低收入和中等收入国家(LMIC)的三级护理中心(LMIC)开发和实施ASP的感知障碍。对斯里兰卡(n = 22)、肯尼亚(12)和坦桑尼亚(11)三级护理医院的45名医生进行了访谈。访谈评估了抗菌素耐药性和ASP的知识、当前的抗菌药物处方做法、获得告知抗菌药物使用的诊断方法的机会、对ASP的接受度以及实施ASP的感知障碍。两名独立审查员使用应用主题分析的原则对访谈进行了编码，并对三个网站的主题进行了比较。提高抗菌药物处方的障碍包括令人望而却步的昂贵的抗菌药物、有限的抗菌药物可获得性、对改变当前抗菌药物处方做法的抵制以及有限的诊断能力。在所有三个地点，这些障碍中最常见的是药品供应有限。在采访之前，这三个网站的许多医生都没有听说过ASP。改进的教育是所有三个地点建议的ASP的一个组成部分。所有三个地点的受访者也在没有提示的情况下建议制定指导方针。虽然大多数参与者认为微生物学结果有助于定制抗生素课程，但也有一些人表示不信任实验室培养结果。人们认为，像血沉和C反应蛋白这样的生物标志物不够特异，不能指导抗菌治疗。尽管先前对ASP的了解有限或一无所知，但大多数受访者都接受执行包括记录和咨询ASP有关抗菌药物处方的协议。我们的研究强调了在LMICs的三个三级护理中心之间共享的实施ASP的几个重要障碍。改善药物可获得性、提高微生物学数据的可得性和可信性、创建当地指南以及向医生提供关于抗菌药物处方的教育是这些设施中的ASP可以采取的重要步骤。
Antimicrobial resistance has been named as one of the top ten threats to public health in the world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce antimicrobial resistance. The purpose of this study was to determine perceived barriers to the development and implementation of ASPs in tertiary care centers in three low- and middle-income countries (LMICs). Interviews were conducted with 45 physicians at tertiary care hospitals in Sri Lanka (n = 22), Kenya (12), and Tanzania (11). Interviews assessed knowledge of antimicrobial resistance and ASPs, current antimicrobial prescribing practices, access to diagnostics that inform antimicrobial use, receptiveness to ASPs, and perceived barriers to implementing ASPs. Two independent reviewers coded the interviews using principles of applied thematic analysis, and comparisons of themes were made across the three sites. Barriers to improving antimicrobial prescribing included prohibitively expensive antimicrobials, limited antimicrobial availability, resistance to changing current practices regarding antimicrobial prescribing, and limited diagnostic capabilities. The most frequent of these barriers in all three locations was limited drug availability. Many physicians in all three sites had not heard of ASPs before the interviews. Improved education was a suggested component of ASPs at all three sites. The creation of guidelines was also recommended, without prompting, by interviewees at all three sites. Although most participants felt microbiological results were helpful in tailoring antibiotic courses, some expressed distrust of laboratory culture results. Biomarkers like erythrocyte sedimentation rate and c-reactive protein were not felt to be specific enough to guide antimicrobial therapy. Despite limited or no prior knowledge of ASPs, most interviewees were receptive to implementing protocols that would include documentation and consultation with ASPs regarding antimicrobial prescribing. Our study highlighted several important barriers to implementing ASPs that were shared between three tertiary care centers in LMICs. Improving drug availability, enhancing availability of and trust in microbiologic data, creating local guidelines, and providing education to physicians regarding antimicrobial prescribing are important steps that could be taken by ASPs in these facilities.
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DOI：
10.4269/ajtmh.2006.75.526
发表时间：
2006-09-01
影响因子：
3.3
作者：
Polage, Christopher R.;Bedu-Addo, George;Petti, Cathy A.
通讯作者：
Petti, Cathy A.
影响因子：
3.7
作者：
Sakeena, M. H. F.;Bennett, Alexandra A.;McLachlan, Andrew J.
通讯作者：
McLachlan, Andrew J.
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。
影响因子：
5.2
作者：
Mathew P;Ranjalkar J;Chandy SJ
通讯作者：
Chandy SJ
影响因子：
4.8
作者：
Kpokiri, Eneyi E.;Taylor, David G.;Smith, Felicity J.
通讯作者：
Smith, Felicity J.
影响因子：
3.7
作者：
Gebretekle, Gebremedhin Beedemariam;Mariam, Damen Haile;Semret, Makeda
通讯作者：
Semret, Makeda