scholarly journals The Mbeya Antimicrobial Stewardship Team: Implementing Antimicrobial Stewardship at a Zonal-Level Hospital in Southern Tanzania

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 107 ◽  
Author(s):  
Jeffrey W. Hall ◽  
Jeannette Bouchard ◽  
P. Brandon Bookstaver ◽  
Matthew S. Haldeman ◽  
Peter Kishimbo ◽  
...  
Keyword(s):  
South Carolina ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Community Pharmacies ◽  
Prescribing Practices ◽  
University Of South Carolina ◽  
Antimicrobial Prescribing ◽  
Resistance Rates ◽  
The University ◽  
New Generation

Background: In 2017, Mbeya Zonal Referral Hospital (MZRH) and the University of South Carolina (UofSC) agreed to collaboratively strengthen antimicrobial prescribing in the southern highlands of Tanzania and train a new generation of clinicians in responsible antimicrobial use. Methods: Key stakeholders and participants were identified and the Mbeya Antimicrobial Stewardship Team (MAST) was created. The team identified assets brought by the collaborators, and four investigations of baseline needs were developed. These investigations included (a) a baseline clinician survey regarding antimicrobial resistance and stewardship, (b) a serial chart review of inpatient antimicrobial prescribing practices, (c) an investigation of antimicrobial resistance rates using existing isolates at the MZRH laboratory, and (d) a survey of antimicrobial availability at community pharmacies in the city. Results: 91% of physicians believe antimicrobial resistance is problem in Tanzania, although only 29% of physicians were familiar with the term “antimicrobial stewardship”. Escherichia coli isolates had resistance rates of over 60% to the commonly used agents ciprofloxacin, trimethoprim-sulfamethoxazole, and ceftriaxone. Thirteen out of 14 community pharmacies offered over-the-counter antibiotics for upper respiratory symptoms. Conclusions: International antimicrobial stewardship collaborations can successfully identify opportunities and needs. Evaluating the team’s efforts to improve patient outcomes will be essential.

scholarly journals Antimicrobial stewardship in rural and remote primary health care: a narrative review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jun Wern Yau ◽  
Sze Mun Thor ◽  
Danny Tsai ◽  
Tobias Speare ◽  
Chris Rissel
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
Narrative Review ◽  
Rural And Remote ◽  
Antimicrobial Prescribing ◽  
Primary Health ◽  
Resistance Rates

Abstract Background Antimicrobial resistance is an emerging problem worldwide and poses a significant threat to human health. Antimicrobial stewardship programmes are being implemented in health systems globally, primarily in hospitals, to address the growing threat of antimicrobial resistance. Despite the significance of primary health care services in providing health care to communities, antimicrobial stewardship programmes are not well established in this sector, especially in rural and remote settings. This narrative review aims to identify in rural and remote primary health care settings the (1) correlation of antimicrobial resistance with antibiotic prescribing and volume of antibiotic use, (2) appropriateness of antimicrobial prescribing, (3) risk factors associated with inappropriate use/prescribing of antibiotics, and (4) effective antimicrobial stewardship strategies. Methods The international literature was searched for English only articles between 2000 and 2020 using specified keywords. Seven electronic databases were searched: Scopus, Cochrane, Embase, CINAHL, PubMed, Ovid Medline and Ovid Emcare. Publication screening and analysis were conducted using Joanna Briggs Institute systematic review tools. Results Fifty-one eligible articles were identified. Inappropriate and excessive antimicrobial prescribing and use directly led to increases in antimicrobial resistance. Increasing rurality of practice is associated with disproportionally higher rates of inappropriate prescribing compared to those in metropolitan areas. Physician knowledge, attitude and behaviour play important roles in mediating antimicrobial prescribing, with strong intrinsic and extrinsic influences including patient factors. Antimicrobial stewardship strategies in rural and remote primary health care settings focus on health care provider and patient education, clinician support systems, utility of antimicrobial resistance surveillance, and policy changes. Results of these interventions were generally positive with decreased antimicrobial resistance rates and improved appropriateness of antimicrobial prescribing. Conclusions Inappropriate prescribing and excessive use of antimicrobials are an important contributor to the increasing resistance towards antimicrobial agents particularly in rural and remote primary health care. Antimicrobial stewardship programmes in the form of education, clinical support, surveillance, and policies have been mostly successful in reducing prescribing rates and inappropriate prescriptions. The narrative review highlighted the need for longer interventions to assess changes in antimicrobial resistance rates. The review also identified a lack of differentiation between rural and remote contexts and Indigenous health was inadequately addressed. Future research should have a greater focus on effective interventional components and patient perspectives.

scholarly journals 166. Barriers to implementing antimicrobial stewardship programs in low- or middle-income country settings: findings from a multi-site qualitative study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S91-S91
Author(s):  
Robert J Rolfe ◽  
Charles M Kwobah ◽  
Florida Muro ◽  
Anushka S Ruwanpathirana ◽  
Furaha Lyamuya ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Antimicrobial Resistance ◽  
Qualitative Study ◽  
Antimicrobial Stewardship ◽  
Perceived Barriers ◽  
Medical Doctors ◽  
Prescribing Practices ◽  
Middle Income ◽  
Antimicrobial Prescribing ◽  
The World

Abstract Background Antimicrobial resistance has been named as one of the top ten threats to health in the world. The World Health Organization has endorsed the implementation of hosptial-based antimicrobial stewardship programs (ASPs) to reduce antimicrobial resistance. We conducted a qualitative study to determine perceived barriers to the development and implementation of ASPs in low- and middle-income countries (LMICs). Methods We conducted 46 interviews with medical doctors at tertiary care hospitals in Sri Lanka (22 doctors), Kenya (12), and Tanzania (12). Interviews assessed knowledge and receptiveness to ASPs and barriers to implementing ASP protocols. Interviews were conducted in English, audio recorded, and transcribed. The interviews discussed knowledge of antimicrobial resistance and ASPs, current antimicrobial prescribing practices, access to diagnostics, receptiveness to ASPs, and perceived barriers to implementing ASPs. Data analysis followed procedures of applied thematic analysis, and used NVivo software. A codebook included structural themes based on the interview questions and emerging inductive themes. Two independent reviewers coded the interviews, and the coding was combined and reviewed for consensus. Themes were synthesized, with comparisons made across the three sites. Results Medical doctors from all three sites discussed multiple barriers to improving antimicrobial prescribing: prohibitively expensive antimicrobials, limited antimicrobial availability, resistance to change current practices regarding antimicrobial prescribing, and limited diagnostic data. The most frequent of these barriers discussed in all three locations was limited drug availability, mentioned by 12/22 physicians in Sri Lanka, 5/12 in Tanzania and 8/12 in Kenya. Improved education was a suggested component of ASPs in all three sites: 7/22 in Sri Lanka, 6/12 in Tanzania, and 6/12 in Kenya. Conclusion The study highlighted several important issues in determining the next steps for the implementation of ASPs in these LMIC hospitals. Improving drug availability and improving education to change physicians’ antimicrobial prescribing practices are important targets that could be addressed by ASPs in these facilities. Disclosures All Authors: No reported disclosures

scholarly journals Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: findings from a multi-site qualitative study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Robert Rolfe ◽  
Charles Kwobah ◽  
Florida Muro ◽  
Anushka Ruwanpathirana ◽  
Furaha Lyamuya ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Perceived Barriers ◽  
Prescribing Practices ◽  
Drug Availability ◽  
Middle Income ◽  
Antimicrobial Prescribing ◽  
Tertiary Care Centers ◽  
Low And Middle Income

Abstract Background Antimicrobial resistance has been named as one of the top ten threats to public health in the world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce antimicrobial resistance. The purpose of this study was to determine perceived barriers to the development and implementation of ASPs in tertiary care centers in three low- and middle-income countries (LMICs). Methods Interviews were conducted with 45 physicians at tertiary care hospitals in Sri Lanka (n = 22), Kenya (12), and Tanzania (11). Interviews assessed knowledge of antimicrobial resistance and ASPs, current antimicrobial prescribing practices, access to diagnostics that inform antimicrobial use, receptiveness to ASPs, and perceived barriers to implementing ASPs. Two independent reviewers coded the interviews using principles of applied thematic analysis, and comparisons of themes were made across the three sites. Results Barriers to improving antimicrobial prescribing included prohibitively expensive antimicrobials, limited antimicrobial availability, resistance to changing current practices regarding antimicrobial prescribing, and limited diagnostic capabilities. The most frequent of these barriers in all three locations was limited drug availability. Many physicians in all three sites had not heard of ASPs before the interviews. Improved education was a suggested component of ASPs at all three sites. The creation of guidelines was also recommended, without prompting, by interviewees at all three sites. Although most participants felt microbiological results were helpful in tailoring antibiotic courses, some expressed distrust of laboratory culture results. Biomarkers like erythrocyte sedimentation rate and c-reactive protein were not felt to be specific enough to guide antimicrobial therapy. Despite limited or no prior knowledge of ASPs, most interviewees were receptive to implementing protocols that would include documentation and consultation with ASPs regarding antimicrobial prescribing. Conclusions Our study highlighted several important barriers to implementing ASPs that were shared between three tertiary care centers in LMICs. Improving drug availability, enhancing availability of and trust in microbiologic data, creating local guidelines, and providing education to physicians regarding antimicrobial prescribing are important steps that could be taken by ASPs in these facilities.

Young Adults’ Perspectives of Childhood Food Allergies: Implications for School Nurses

2021 ◽  
pp. 105984052110190
Author(s):  
Abigail Anderson ◽  
Elizabeth M. Combs ◽  
Sheila Hurst ◽  
Cynthia F. Corbett
Keyword(s):  
Young Adults ◽  
South Carolina ◽  
School Nurses ◽  
Food Allergies ◽  
School Age Children ◽  
School Age ◽  
University Of South Carolina ◽  
Social Lives ◽  
Qualitative Descriptive ◽  
The University

The primary goal of this study was to examine young adults’ perspectives about the effects of their food allergies (FAs) on their social lives from school-age to young adulthood. Young adults aged 18–21 ( n = 10) at the University of South Carolina were interviewed. A qualitative descriptive method to find themes and commonalities from transcribed interviews was used for data analysis. Identified themes were (1) feeling different and being isolated, (2) strategies for managing feeling different and being isolated, (3) strategies for managing safety, and (4) acceptance of myself and by others. School-age children attributed the school lunch allergy table as contributing to social isolation. Additionally, participants described feeling different and concerns about safety. Strategies to mitigate those experiences were identified by participants. Implications for children with FAs, their parents, school nurses, and other education and health professionals who work with children are presented.

scholarly journals Substance Use Disorder: A Model for Integration in Undergraduate Medical Education

2021 ◽  
Vol 8 ◽  
pp. 238212052110258
Author(s):  
Haritha Pavuluri ◽  
Nicolas Poupore ◽  
William Michael Schmidt ◽  
Samantha Gabrielle Boniface ◽  
Meenu Jindal ◽  
...  
Keyword(s):  
Medical Education ◽  
Substance Use ◽  
South Carolina ◽  
Substance Use Disorder ◽  
The United States ◽  
University Of South Carolina ◽  
Community Recovery ◽  
School Of Medicine ◽  
Treatment Gaps ◽  
The University

Substance Use Disorder (SUD) is a debilitating chronic illness with significant morbidity and mortality across the United States. The AAMC and LCME have supported the efforts for more effective medical education of SUD to address the existing stigma, knowledge, and treatment gaps. The Coronavirus 2019 (COVID-19) pandemic and associated social, economic, and behavioral impacts have added to this urgency. The University of South Carolina School of Medicine Greenville (USCSOMG), in collaboration with community organizations, has successfully implemented an integrated SUD education curriculum for medical students. Students learn about SUD in basic sciences, receive case-based education during clinical exercises, and are provided the opportunity to become a recovery coach and participate in the patient and family recovery meetings through this curriculum during preclinical years. During the clinical years, SUD education is enhanced with exposure to Medication for Addition Treatment (MAT). Students also partake in the care coordination of patients with SUD between the hospital and community recovery organizations. All students receive MAT waiver training in their final year and are prepared to prescribe treatment for SUD upon graduation. The experiences in this integrated curriculum integration can perhaps assist other organizations to implement similar components and empower the next generation of physicians to be competent and effective in treating patients with SUD.

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