Technology to Support Integrated Antimicrobial Stewardship Programs: A User Centered and Stakeholder Driven Development Approach

Jong, Nienke Beerlage-de; Gemert-Pijnen, Lisette van; Wentzel, Jobke; Hendrix, Ron; Siemons, Liseth

doi:10.4081/idr.2017.6829

Cited by 23 publications

(26 citation statements)

References 14 publications

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“…eHealth has the potential to support and improve synchronisation AMR education, communication, and surveillance and performance feedback in a cross-border region, as has been successfully shown before in AMR studies [45, 78–81]. By following a participatory, holistic and human centred approach for eHealth development and implementation, eHealth has the potential advantage of being able to adapt to differences in the users’ needs (e.g.…”

Section: Discussionmentioning

confidence: 90%

Cross-border comparison of antimicrobial resistance (AMR) and AMR prevention measures: the healthcare workers’ perspective

Keizer

Braakman-Jansen

Kampmeier

et al. 2019

Antimicrob Resist Infect Control

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Background Cross-border healthcare may promote the spread of multidrug-resistant microorganisms (MDRO) and is challenging due to heterogeneous antimicrobial resistance (AMR) prevention measures (APM). The aim of this article is to compare healthcare workers (HCW) from Germany (DE) and The Netherlands (NL) on how they perceive and experience AMR and APM, which is important for safe patient exchange and effective cross-border APM cooperation. Methods A survey was conducted amongst HCW ( n = 574) in hospitals in DE ( n = 305) and NL ( n = 269), using an online self-administered survey between June 2017 and July 2018. Mann-Whitney U tests were used to analyse differences between answers of German and Dutch physicians ( n = 177) and German and Dutch nurses ( n = 397) on 5-point Likert Items and Scales. Results Similarities between DE and NL were a high awareness about the AMR problem and the perception that the possibility to cope with AMR is limited (30% respondents perceive their contribution to limit AMR as insufficient). Especially Dutch nurses scored significantly lower than German nurses on their contribution to limit AMR (means 2.6 vs. 3.1, p ≤ 0.001). German HCW were more optimistic about their potential role in coping with AMR (p ≤ 0.001), and scored higher on feeling sufficiently equipped to perform APM ( p ≤ 0.003), although the mean scores did not differ much between German and Dutch respondents. Conclusions Although both German and Dutch HCW are aware of the AMR problem, they should be more empowered to contribute to limiting AMR through APM (i.e. screening diagnostics, infection diagnosis, treatment and infection control) in their daily working routines. The observed differences reflect differences in local, national and cross-border structures, and differences in needs of HCW, that need to be considered for safe patient exchange and effective cross-border APM. Electronic supplementary material The online version of this article (10.1186/s13756-019-0577-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 90%

Cross-border comparison of antimicrobial resistance (AMR) and AMR prevention measures: the healthcare workers’ perspective

Keizer

Braakman-Jansen

Kampmeier

et al. 2019

Antimicrob Resist Infect Control

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“…Simultaneously, with greater enforcement of over-the-counter dispensing regulations, it should also be recognised that in rural areas where veterinary hospitals or practitioners may be scarce, this may negatively impact upon equine owners' accessibility to medicine, and consequently upon their livelihoods. Further studies are therefore required to identify realistic interventions to bridge what has become a 'wicked problem' [32] in India and other less economically developed countries.…”

Section: Discussionmentioning

confidence: 99%

No Prescription, No Problem! A Mixed-Methods Study of Antimicrobial Stewardship Relating to Working Equines in Drug Retail Outlets of Northern India

Nye

Watson²,

Kubasiewicz³

et al. 2020

Antibiotics

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Multidrug resistance (MDR) is already occurring among some equids in India. Donkeys and mules are a mobile species moving between regions and international borders, often populating areas of India where private community pharmacies, or medical stores, are the primary healthcare provider for both humans and animals. This article highlights how the capacities of drug retail outlet workers might affect their antibiotic dispensing practices, particularly in relation to donkeys and mules, in order to consider how this might impact the development of antimicrobial resistance (AMR) on a wider scale. A mixed-methods approach was implemented using patient simulation method (n = 28), semi-structured interviews (SSIs) (n = 23), focus group discussions (FGDs) with veterinary practitioners and non-governmental organisation animal health workers (n = 2 FGDs), and participant observation. Fewer than 48 per cent of drug retail outlet workers admitted to having had any formal training in pharmaceuticals at all, while 78 per cent reported having no formal training in animal-related pharmaceuticals. Moreover, 35 per cent of all participants sold antibiotics without a prescription, unprompted and without specifically being asked for antibiotics. Of the antibiotics dispensed, only 21 per cent were correctly dispensed for the symptoms presented, and all dosages dispensed were incorrect (underdosed). Furthermore, 43 per cent of drug retail outlet workers interviewed believe that some antibiotics can be legally dispensed without a prescription. Equine owners in northern India are frequently being sold antibiotics without a prescription and, in most cases, with incorrect diagnoses, treatment choice, and dosage. A substantial gap in capacities exists amongst Drug Retail Outlet (DRO) workers, with few being sufficiently qualified or trained to dispense antibiotics to animal owners. The study highlights the need for further training of private DRO workers as well as knowledge extension and awareness training for both DRO workers and animal owners regarding antimicrobial resistance and its potential impact upon livelihoods. It also illustrates the need to identify a balance whereby greater enforcement of regulation at all levels is implemented, while at the same time maintaining sufficient access to medicine for rural populations.

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“…by using data visualizations). The CeHRes-roadmap [ 10 ] could guide the planning, coordination and execution of a participatory development process of data-driven APM-AF, since it fits well with the wicked AMR-problem because of its socio-technical and interdisciplinary-based participatory principles [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

Finding the match between healthcare worker and expert for optimal audit and feedback on antimicrobial resistance prevention measures

Keizer

Jong

Naiemi

et al. 2020

Antimicrob Resist Infect Control

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Background: The potentials of audit and feedback (AF) to improve healthcare are currently not exploited. To unlock the potentials of AF, this study focused on the process of making sense of audit data and translating data into actionable feedback by studying a specific AF-case: limiting antimicrobial resistance (AMR). This was done via audit and feedback of AMR prevention measures (APM) that are executed by healthcare workers (HCW) in their day-today contact with patients. This study's aim was to counterbalance the current predominantly top-down, expert-driven audit and feedback approach for APM, with needs and expectations of HCW. Methods: Qualitative semi-structured interviews were held with sixteen HCW (i.e. physicians, residents and nurses) from high-risk AMR departments at a regional hospital in The Netherlands. Deductive coding was succeeded by open and axial coding to establish main codes, subcodes and variations within codes. Results: HCW demand insights from audits into all facets of APM in their working routines (i.e. diagnostics, treatment and infection control), preferably in the form of simple and actionable feedback that invites interdisciplinary discussions, so that substantiated actions for improvement can be implemented. AF should not be seen as an isolated ad-hoc intervention, but as a recurrent, long-term, and organic improvement strategy that balances the primary aims of HCW (i.e. improving quality and safety of care for individual patients and HCW) and AMR-experts (i.e. reducing the burden of AMR). Conclusions: To unlock the learning and improvement potentials of audit and feedback, HCW' and AMR-experts' perspectives should be balanced throughout the whole AF-loop (incl. data collection, analysis, visualization, feedback and planning, implementing and monitoring actions). APM-AF should be flexible, so that both audit (incl. collecting and combining the right data in an efficient and transparent manner) and feedback (incl. persuasive and actionable feedback) can be tailored to the needs of various target groups. To balance HCW' and AMR-experts' perspectives a participatory holistic AF development approach is advocated.

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Technology to Support Integrated Antimicrobial Stewardship Programs: A User Centered and Stakeholder Driven Development Approach

Cited by 23 publications

References 14 publications

Cross-border comparison of antimicrobial resistance (AMR) and AMR prevention measures: the healthcare workers’ perspective

Cross-border comparison of antimicrobial resistance (AMR) and AMR prevention measures: the healthcare workers’ perspective

No Prescription, No Problem! A Mixed-Methods Study of Antimicrobial Stewardship Relating to Working Equines in Drug Retail Outlets of Northern India

Finding the match between healthcare worker and expert for optimal audit and feedback on antimicrobial resistance prevention measures

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