Health care providers’ perceptions regarding antimicrobial stewardship programs (AMS) implementation—facilitators and challenges: a cross-sectional study in the Eastern province of Saudi Arabia

Abstract

Background Infections result from invasions of an organism into body tissues leading to diseases and complications that might eventually lead to death. Inappropriate use of antimicrobials has led to development of antimicrobial resistance (AMR) which has been associated with increased mortality, morbidity and health costs. Antimicrobial stewardship (AMS) programs are designed to ensure appropriate selections of an effective antimicrobial drugs and optimizing antibiotic use to minimize antibiotic resistance by implementing certain policies, strategies and guidelines. The aim of this study was to investigate practitioners’ perceptions regarding AMS implementation and to identify challenges and facilitators of these programs execution. Methods Cross-sectional study among health care providers in Eastern province of Saudi Arabia Hospitals. The data was collected using a survey including questions about demographic data and information about clinicians’ (physicians, pharmacists and nurses) previous experience with AMS and prescribing of antibiotics, the level of knowledge and attitudes regarding AMS programs’ implementation. Results More than 50% of clinicians (N = 184) reported lack of awareness of AMS programs and their components, whereas 71.2% do not have previous AMS experience. The majority of clinicians (72.3%) noticed increasing number of AMR infections over the past 5 years and (69.6%) were involved in care of patients with an antibiotic-resistant infection. Around 77.2% of respondents reported that formulary management can be helpful for AMS practice and majority of respondents (79.9%) reported that the availability of pathogens and antimicrobial susceptibility testing can be helpful for AMS. Major barriers to AMS implementation identified were lack of internal policy/guidelines and specialized AMS information resources. Lack of administrative awareness about AMS programs; lack of personnel, time limitation, limited training opportunities, lack of confidence, financial issue or limited funding and lack of specialized AMS information resources were also reported 65.8%, 62.5%, 60.9%, 73.9%, 50%, 54.3 and 74.5%, respectively. Conclusion Our study identified comprehensive education and training needs for health care providers about AMS programs. Furthermore, it appears that internal policy and guidelines need revision to ensure that the health care providers work consistently with AMS. Future research must focus on the benefit of implementing AMS as many hospitals are not implementing AMS as revealed by the clinicians. We recommend policy makers and concerned health authorities to consider the study findings into account to optimize AMS implementation.

Evaluation of Antimicrobial Stewardship Programs (ASPs) and their perceived level of success at Makkah region hospitals, Kingdom of Saudi Arabia

“…Interestingly, we found formulary restrictions (89%) and feedback on prescribing to physicians (68%) as most common ASP interventions with high suggested success in hospitals. These findings are consistent with previous surveys conducted in Saudi settings ( Baraka et al, 2019 , Enani, 2016 ).…”

“…A recent study in the Eastern province of Saudi Arabia on ASP in region hospitals revealed that the majority of clinicians were aware of ASP components and reported lack of role of administration and lack of funds and training in antimicrobial stewardship in institutions. ( Baraka et al, 2019 ). In another qualitative study by Alghamdi et al conducted in three hospitals in Saudi Arabia reported lack of enforcement of antimicrobial prescribing policies and guidelines, physicians fear and concerns influence their acceptance of ASP interventions ( Alghamdi et al, 2019 ).…”

Antimicrobial-stewardship Knowledge, attitude, and practice among professional physicians in Saudi hospitals

“…Most of the participants in the present study were male and had an experience of up to 10 years. This was in accord with the indings of the Indian study (Badar et al, 2018) as well as another Saudi study (Baraka et al, 2019).…”

“…Majority of the 180 (43.6%) participants were from the central region and practising medicine speciality 190 (46%).One of the chief factors in the suppression of AMR is by the decline of inconsistent antimicrobial employment and alteration of prescribing behaviour of the clinicians may perhaps bring about this to a considerable extent (Al-Harthi et al, 2015). Unless and until 12 hours after traumatic wound 5 1.3% perceptions and attitudes of health care providers' regarding AM are understood, every learning intercession on AMR and AMS programs will be a failure (Baraka et al, 2019). Thus the present study was conducted to explore the KAP regarding antibiotic stewardship program in physicians at Riyadh.…”

“…In Saudi Arabia, the national AMS program set in motion in 2014, is a component of the pharmacy strategic plan of the Ministry of Health, and its complete execution has been achieved in 2018 (Alomi, 2015), (Alomi, 2017). Relatively few studies of knowledge, attitude, and practice are published about antimicrobial-stewardship concerning microbial resistance in Saudi Arabia (Baraka et al, 2019), (Al-Harthi et al, 2015). It was therefore found appropriate to assess the knowledge, attitude and practices regarding antibiotic stewardship programme among professional physicians in Riyadh, Saudi Arabia.…”