Antimicrobial Stewardship Programs in Community Health Systems Perceived by Physicians and Pharmacists: A Qualitative Study with Gap Analysis

Abstract

Antimicrobial stewardship program (ASP) is one of the most important strategies for managing infectious disease treatment and preventing antimicrobial resistance. The successful implementation of ASP in the community health system (CHS) has been challenging. We evaluated perceptions of current ASP, potential setbacks of ASP implementation, and future demands on ASP services among physicians and pharmacists in the CHS. The qualitative research was conducted through in-depth individual interviews and focus group discussions with 11 physicians and 11 pharmacists. In addition, a quantitative gap analysis was conducted to assess the different awareness and demands on services of ASP and preferred antimicrobial-related problems (ARP). In overall, perceptions of ASP varied by profession. The identified setbacks were unorganized institutional leadership, the undefined roles of healthcare professionals, a lack of reimbursement, the hierarchical structure of the health system, and the labor-intensive working environment of pharmacy services. Although demands for ASP improvement were similar among professionals, they had different preferences in prioritizing each service item of ASP/ARP development and the profession responsible for each service. Continuous administrative and financial investments, understanding ASP contents, ASP-specific information technology, and interdisciplinary collaboration with good communication among healthcare professions are needed to continue the progression of ASP.

Are We Making the Most of Community Pharmacies? Implementation of Antimicrobial Stewardship Measures in Community Pharmacies: A Narrative Review

“…Pharmacists greatly contribute to the development and implementation of stewardship programs, they educate other health care members, and track, report and assess the effectiveness of stewardship strategies. Including a pharmacist is the starting point of antimicrobial stewardship program team building and can promote consensus in multidisciplinary healthcare teams regarding prescription rights [ 4 , 76 , 77 ]. In transition from inpatient to outpatient care, pharmacists may contribute to limiting overall inappropriate antimicrobial prescribing, optimize antibiotic selection, dose or reduce treatment duration [ 44 ].…”

Validation of a Questionnaire for Patient Awareness and the Need for a Community-Based Outpatient Antimicrobial Stewardship Program (O-ASP): A Pilot Study

“…Therefore, in this study, we developed and validated a questionnaire assessing patient awareness of antimicrobial use and the need for community-based PCS in the O-ASP based on ASP guidelines as well as PCS guidelines [ 13 , 18 ]. Although many previous studies evaluated the knowledge, attitude, and/or perception regarding antimicrobial stewardship among healthcare professional students and clinicians, such as physicians, nurses, dentists, and pharmacists [ 19 ], those assessing patient awareness and the need for pharmacist involvement in the O-ASP were scarce. To our knowledge, our study is the first study to develop and demonstrate the validity of a new questionnaire to investigate patients’ understanding of antimicrobial use and the need for pharmacist involvement in the ASP, particularly in the outpatient setting.…”

“…This may account for the relatively low rate (<70%) of the perceived appropriateness of antibiotic prescribing among patients, as in our present study ( Table 3 ). According to a recent study conducted in Korea, approximately ≤50% of physicians were aware of the standard duration of antibiotic therapy recommended by the clinical practice guidelines [ 19 ]. Similar results have been published in other countries regarding the knowledge of physicians concerning appropriate antimicrobial use, with the antimicrobial knowledge score ranging from 0% to 80% [ 28 , 29 ].…”

Evaluation of a successful fluoroquinolone restriction intervention among high-risk patients: A mixed-methods study

“…Our interviewees identified the strength of our institution's ASP and the involvement of clinical pharmacists as key facilitators to the success of the fluoroquinolone restriction intervention. Clearly defining and dedicating resources to the ASP is necessary for success [29,30]. The importance of pharmacy involvement in ASPs as well as assistance with antimicrobial optimization at the patient level has been well described [30,33,37,31].…”

“…Clearly defining and dedicating resources to the ASP is necessary for success [29,30]. The importance of pharmacy involvement in ASPs as well as assistance with antimicrobial optimization at the patient level has been well described [30,33,37,31]. Key facilitators of success for our institution's ASP initiatives as well as those from the literature has informed a larger scale restriction intervention.…”