Background Perceived patient demand for antibiotics drives unnecessary antibiotic prescribing in outpatient settings, but little is known about how clinicians experience this demand or how this perceived demand shapes their decision-making. Objective To identify how clinicians perceive patient demand for antibiotics and the way these perceptions stimulate unnecessary prescribing. Methods Qualitative study using semi-structured interviews with clinicians in outpatient settings who prescribe antibiotics. Interviews were analyzed using conventional and directed content analysis. Results Interviews were conducted with 25 clinicians from nine practices across three states. Patient demand was the most common reason respondents provided for why they prescribed non-indicated antibiotics. Three related factors motivated clinically unnecessary antibiotic use in the face of perceived patient demand: (i) clinicians want their patients to regard clinical visits as valuable and believe that an antibiotic prescription demonstrates value; (ii) clinicians want to avoid negative repercussions of denying antibiotics, including reduced income, damage to their reputation, emotional exhaustion, and degraded relationships with patients; (iii) clinicians believed that certain patients are impossible to satisfy without an antibiotic prescription and felt that efforts to refuse antibiotics to such patients wastes time and invites the aforementioned negative repercussions. Clinicians in urgent care settings were especially likely to describe being motivated by these factors. Conclusion Interventions to improve antibiotic use in the outpatient setting must address clinicians’ concerns about providing value for their patients, fear of negative repercussions from denying antibiotics, and the approach to inconvincible patients.
Languages vary in their semantic partitioning of the world. This has led to speculation that language might shape basic cognitive processes. Spatial cognition has been an area of research in which linguistic relativity-the effect of language on thought-has both been proposed and rejected. Prior studies have been inconclusive, lacking experimental rigor or appropriate research design. Lacking detailed ethnographic knowledge as well as failing to pay attention to intralanguage variations, these studies often fall short of defining an appropriate concept of language, culture, and cognition. Our study constitutes the first research exploring (1) individuals speaking different languages yet living (for generations) in the same immediate environment and (2) systematic intralanguage variation. Results show that language does not shape spatial cognition and plays at best the secondary role of foregrounding alternative possibilities for encoding spatial arrangements.
Background: In May 2018, The Joint Commission, The Pew Charitable Trusts, and the CDC cosponsored a meeting of experts who identified 6 evidence-based leading practices that antimicrobial stewardship programs (ASPs) should be doing beyond having basic infrastructure for improving antibiotic prescribing. The Joint Commission Department of Research working with external experts in 2020 conducted a prevalence study to assess what proportion of Joint Commission-accredited hospitals had implemented the 6 leading practices identified (results presented at SHEA Spring 2021). In this qualitative study, we collected information about how hospitals implemented ASP leading practices to identify facilitators and barriers to implementation among diverse hospitals. Methods: We conducted in-depth telephone interviews with a subset of ASP leaders from hospitals that participated in the 2020 prevalence study. We used purposive sampling to select 30 hospitals from 288 hospitals based on leading practices implemented, hospital size, and system membership. An experienced qualitative researcher (M.K.) not previously affiliated with the Joint Commission interviewed all participants using a semistructured interview guide. The framework method of analysis was used to review and organize data. We used the constant comparative approach to ensure that factors were not missed. Each transcript was reviewed by at least 2 researchers who compared coded findings in group discussion sessions. Two researchers independently identified key factors and combined findings following discussion and review. We focused on super factors that are relevant to implementing multiple leading practices. Results: ASP leaders from 30 hospitals were interviewed. Participating hospitals were evenly distributed across hospital size (10 small, 10 medium, 10 large) and membership in a health system (16 system, 14 nonsystem). At least 14, (46.7%) interviewees had pharmacist in their title; 11 (36.7%) had pharmacist-antimicrobial stewardship; and 5 (16.6%) had other titles (eg, infection preventionist). Super factors included ASP team capacity, ID expertise, having a physician champion, relationships with clinicians and relevant departments, structure of electronic health records, adequate software, and information technology resources. Small and rural nonsystem hospitals often lacked resources related to ID expertise, dedicated staff, and software tools, whereas hospitals that belong to a system benefit from centralized ID expertise and technical infrastructure provided. Conclusions: Specific factors related to personnel, relationships and IT resources have an outsized impact on implementing multiple leading antimicrobial stewardship practices in hospitals. Hospital ASPs could benefit by targeting resources toward these areas.Funding: NoneDisclosures: None
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