Knowledge and perceptions of junior and senior Spanish resident doctors about antibiotic use and resistance: Results of a multicenter survey

Francisco, Carolina Navarro-San; Toro, María Dolores del; Cobo, Javier; Gea-García, J.H. de; Vañó‐Galván, Sergio; Moreno-Ramos, Francisco; Rodríguez-Baño, Jesús; Paño‐Pardo, José Ramón

doi:10.1016/j.eimc.2012.05.016

Cited by 59 publications

(65 citation statements)

References 17 publications

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“…This can be attributed to low level of knowledge about the problem in Egypt and its rate, while their high perception of the problem in their hospital explained by most the doctors (90.9%) believed that antibiotics are over used in their hospital and (74.9%) believed that antibiotics are of low quality (fig, 5). This result is similar to Srinivasan et al (2004), Navarro et al (2013) [5], [15] [19] was similar to our study who found that a large number of participants believed that physicians prescribe antimicrobials more often than necessary (86.7% of respondents agreed or strongly agreed with this statement), and they perceived the role of inappropriate antimicrobial use as an important cause of the emergence of antimicrobial resistance (97.7% of respondents agreed or strongly agreed that this was a cause). On the other hand, this result was inconsistent with Garcia et al(2011) [12] as regard to the need to apply for approval to prescribe restricted antibiotics caused them to seek an alternative antibiotics, poor quality of antibiotics in the hospital and patient demand as thriving factor [12] .…”

Section: Perceptionsupporting

confidence: 79%

Assessment of knowledge, perception of resident doctors regarding antibiotic resistance and prescription practice at zagazig university hospital, 2013

Eltwansy

2014

International Journal of Basic and Applied Sciences

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Background: Antibiotics are among the most frequently prescribed drugs worldwide. The overuse and/ or misuse of antibiotics can result in significant consequences as antimicrobial resistance, therapeutic failures, drug toxicities and drug interactions. Since antibiotics are medications that mainly prescribed by physicians, any action aimed at improving use of antimicrobials must necessarily target physicians. Objectives: To assess knowledge, perception and practice of the resident doctors about antibiotic resistance and antibiotic prescription at Zagazig University Hospital and to identify factors affecting them. Methodology: A cross-sectional survey was done at Zagazig University teaching hospital between July and September 2013. Self-administrated questionnaire were used to assess resident doctors' knowledge, perception and practice about antibiotics. Results: From 195 target physicians, 175 agreed to participate. The mean score of knowledge about quiz answer, perception about resistance and perception about prescription were (3.6, 3.8, and 3.2 respectively). The age of the resident doctors was statistically significant affecting answering of the eight quizzes and in the perception about antibiotics resistance (P=0.00) The answering of the eight quizzes, perception about antibiotics resistance and perception about antimicrobial prescription were significantly higher among male doctors than female doctors (P=0.000). There was also significant association between experience (> 2years) and the answering of the eight quizzes, perception about antibiotics resistance (P=0.000). Age groups, answering of the eight quizzes, the perception about antibiotics resistance and perception about antimicrobial prescription were statistically significantly affecting practice of resident doctors about antibiotic prescription ( P<0.05). Conclusion: This study concluded that knowledge of resident doctors and perception about antibiotic prescription was suboptimal. The perception about antibiotic resistance was very high, while doctors' practice in prescribing antibiotic was satisfactory.

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Section: Perceptionsupporting

confidence: 79%

Assessment of knowledge, perception of resident doctors regarding antibiotic resistance and prescription practice at zagazig university hospital, 2013

Eltwansy

2014

International Journal of Basic and Applied Sciences

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“…This practice should be encouraged because poor patient adherence to prescribed antibiotics is the major untoward ABS attitude resulting in ABR (Pulcini et al, 2011;Navarro-San Francisco et al, 2013;Abera et al, 2014;Burger et al, 2016). Clients/patients' wrong habits and their lack of knowledge is also a leading cause for ABR (Scaioli et al, 2015;Coyne et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Overuse of antibiotic may result from the clinician intention to fulfill the responsibility of offering optimal therapy for the individual patient under his/her care while overlooking the responsibility of preserving the efficacy of antibiotics and minimizing the development of resistance in the same patient and other patients in the future and to public health (Pulicini and Gyssens, 2013;Scaioli et al, 2015). Widespread and overuse of antibiotics, use of broadspectrum antibiotics when narrow spectrum is available are among the leading causes of ABR (Pulcini et al, 2011;Navarro-San Francisco et al, 2013;Abera et al, 2014;Burger et al, 2016). In ABS, clinicians are encouraged that where it is imperative to start effective broad-spectrum therapy quickly, subsequent daily review of these prescriptions, and de-escalation to narrow-spectrum antibiotics where possible, should be done (Wickens et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Veterinarians’ Perception, Knowledge and Practices of Antibiotic Stewardship in Enugu State Southeast, Nigeria

Anyanwu¹,

Kolade²

2017

Not Sci Biol

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A cross-sectional survey utilizing structured questionnaires was used to study the veterinarians' perception, knowledge and practices of antibiotic stewardship (ABS) in Enugu State, Southeastern Nigeria. Data obtained were analyzed using chi-square on SPSS (Version 15.0) at a significance level of P < 0.05 to determine possible associations between variables and perceptions/knowledge about ABS. Out of 280 respondents, 41 (17.1%) had heard about ABS. Minority of the respondents perceived/knew that using antibiotics only when necessary (6.4%, 18), administering antibiotics at the appropriate dose (6.4%, 18) and administering antibiotics for appropriate duration in every case (4.3%, 12) were among the principles of ABS. The study also showed that age, gender, qualification, years of practice and locations did not exert any influence (P > 0.05) on the awareness of respondents about ABS. More than one-third of the respondents wrongly perceived that increasing the use of broad-spectrum antibiotics (35.4%, 99) is one of the goals of ABS, whereas the minority of the respondents rightly perceived/knew that minimizing toxicity and other adverse effects (16.8%, 47) and reducing antibiotic resistance (ABR) (43.2%, 121) are also goals of ABS. Only 21.4% (60) had overall knowledge of ABS. Prescribing antibiotics without seeing/examining the patient, prescribing antibiotics for any case suspected to be infectious, prescribing broad-spectrum antibiotics despite availability of narrow-spectrum antibiotics, prescribing different classes/types of antibiotics concurrently to ensure therapeutic efficacy, prescribing overdose of antibiotics to ensure efficacy and non-consultation of the veterinary formulary/other resources when in doubt during prescription, are some of inappropriate/untoward ABS practices/behaviors/attitudes amongst the respondents. No significant association (P > 0.05) was found between practices of ABS and age, gender, qualification, years of practice and location. In conclusion, the veterinarians' awareness/perception and practices of ABS is abysmally poor in the study area, thus education of Nigerian veterinarians about ABS and the teaching of the principles and practices of ABS during veterinary schools are recommended.

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“…Feedback interventions can include informal ward-based teaching, one-to-one specialised education, repeated peer review or feedback during teaching rounds. 43,76,125,126,[167][168][169][170][171] Consistent with wider literature on audit and feedback interventions, effectiveness is deemed to be associated with mode of delivery, source of feedback and whether or not feedback is tied to specific actions and targets. [172][173][174] When education and feedback interventions are disconnected from how prescribing decisions are made in the workplace, they are less likely to result in meaningful and sustainable change, as a result of the important influence of clinical hierarchies.…”

Section: Education and Feedback Interventionsmentioning

confidence: 64%

“…10,64,67,74,76,88,92,101,105,107,108,[162][163][164] This emphasis is underpinned by an assumption that, having identified misplaced beliefs and erroneous prescribing decisions, one can improve the knowledge 'deficit' by delivering targeted education (i.e. a teaching session on a specific aspect of antimicrobial prescribing).…”

Section: Education and Feedback Interventionsmentioning

confidence: 99%

Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

Papoutsi

Mattick

Pearson

et al. 2018

Health Serv Deliv Res

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BackgroundInterventions to improve the antimicrobial prescribing practices of doctors have been implemented widely to curtail the emergence and spread of antimicrobial resistance, but have been met with varying levels of success.ObjectivesThis study aimed to generate an in-depth understanding of how antimicrobial prescribing interventions ‘work’ (or do not work) for doctors in training by taking into account the wider context in which prescribing decisions are enacted.DesignThe review followed a realist approach to evidence synthesis, which uses an interpretive, theory-driven analysis of qualitative, quantitative and mixed-methods data from relevant studies.SettingPrimary and secondary care.ParticipantsNot applicable.InterventionsStudies related to antimicrobial prescribing for doctors in training.Main outcome measuresNot applicable.Data sourcesEMBASE (via Ovid), MEDLINE (via Ovid), MEDLINE In-Process & Other Non-Indexed Citations (via Ovid), PsycINFO (via Ovid), Web of Science core collection limited to Science Citation Index Expanded (SCIE) and Conference Proceedings Citation Index – Science (CPCI-S) (via Thomson Reuters), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, the Health Technology Assessment (HTA) database (all via The Cochrane Library), Applied Social Sciences Index and Abstracts (ASSIA) (via ProQuest), Google Scholar (Google Inc., Mountain View, CA, USA) and expert recommendations.Review methodsClearly bounded searches of electronic databases were supplemented by citation tracking and grey literature. Following quality standards for realist reviews, the retrieved articles were systematically screened and iteratively analysed to develop theoretically driven explanations. A programme theory was produced with input from a stakeholder group consisting of practitioners and patient representatives.ResultsA total of 131 articles were included. The overarching programme theory developed from the analysis of these articles explains how and why doctors in training decide to passively comply with or actively follow (1) seniors’ prescribing habits, (2) the way seniors take into account prescribing aids and seek the views of other health professionals and (3) the way seniors negotiate patient expectations. The programme theory also explains what drives willingness or reluctance to ask questions about antimicrobial prescribing or to challenge the decisions made by seniors. The review outlines how these outcomes result from complex inter-relationships between the contexts of practice doctors in training are embedded in (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels and application in practice) and the mechanisms triggered in these contexts (fear of criticism and individual responsibility, reputation management, position in the clinical team and appearing competent). Drawing on these findings, we set out explicit recommendations for optimal tailoring, design and implementation of antimicrobial prescribing interventions targeted at doctors in training.LimitationsMost articles included in the review discussed hospital-based, rather than primary, care. In cases when few data were available to fully capture all the nuances between context, mechanisms and outcomes, we have been explicit about the strength of our arguments.ConclusionsThis review contributes to our understanding of how antimicrobial prescribing interventions for doctors in training can be better embedded in the hierarchical and interprofessional dynamics of different health-care settings.Future workMore work is required to understand how interprofessional support for doctors in training can contribute to appropriate prescribing in the context of hierarchical dynamics.Study registrationThis study is registered as PROSPERO CRD42015017802.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Knowledge and perceptions of junior and senior Spanish resident doctors about antibiotic use and resistance: Results of a multicenter survey

Cited by 59 publications

References 17 publications

Assessment of knowledge, perception of resident doctors regarding antibiotic resistance and prescription practice at zagazig university hospital, 2013

Assessment of knowledge, perception of resident doctors regarding antibiotic resistance and prescription practice at zagazig university hospital, 2013

Veterinarians’ Perception, Knowledge and Practices of Antibiotic Stewardship in Enugu State Southeast, Nigeria

Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

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