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Behavioral Components and Context of Antimicrobial Prescription in a Tertiary Hospital in Portugal

Consumption of antimicrobials is an important driver of antimicrobial resistance. There is limited knowledge of the key determinants of antimicrobial prescribing behavior in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quali...

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Autores principales: Almeida-Costa, Ana Paula Muniz, Paiva, José-Artur, Almeida, António Jorge Santos, Barbosa, Elisabete, Correia, Sofia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10295435/
https://www.ncbi.nlm.nih.gov/pubmed/37370351
http://dx.doi.org/10.3390/antibiotics12061032
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author Almeida-Costa, Ana Paula Muniz
Paiva, José-Artur
Almeida, António Jorge Santos
Barbosa, Elisabete
Correia, Sofia
author_facet Almeida-Costa, Ana Paula Muniz
Paiva, José-Artur
Almeida, António Jorge Santos
Barbosa, Elisabete
Correia, Sofia
author_sort Almeida-Costa, Ana Paula Muniz
collection PubMed
description Consumption of antimicrobials is an important driver of antimicrobial resistance. There is limited knowledge of the key determinants of antimicrobial prescribing behavior in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in Antimicrobial Stewardship Programs (ASP). This study aimed to describe the main factors that influence the doctor’s decision on antimicrobials prescribing and to identify the behaviors that drive physicians’ decision making. A structured web-based questionnaire focused on behavioral components of antimicrobial prescription was applied to the medical staff of three different departments—Internal Medicine, General Surgery, and Intensive Care Medicine—of a university hospital. All doctors agreed that inadequate use of antimicrobials increases AMR. A total of 77% of the surgeons and 100% of the internists and intensivists perceived antimicrobial prescription as a priority in the department. Full autonomy in antimicrobial prescription was preferred by internists (64%) but not by surgeons (18%) and intensivists (24%). Most physicians were keen to have ASP advice, but most did not want advice from colleagues of the same service. Almost all surgeons ask for advice when prescribing, but only 68% of the internists do it. Less than half of all physicians and only 25% of the surgeons felt free to prescribe contrary to guidelines. Most physicians, particularly in Intensive Care Medicine (94%), adopt the “wait and see” strategy when no microbiologic confirmation is available, but 27% of the surgeons start empirical therapy. In conclusion, the context of antimicrobial prescription, autonomy, and confidence in antimicrobial prescription demonstrated heterogeneity between the three departments and this should be considered when planning ASP.
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spelling pubmed-102954352023-06-28 Behavioral Components and Context of Antimicrobial Prescription in a Tertiary Hospital in Portugal Almeida-Costa, Ana Paula Muniz Paiva, José-Artur Almeida, António Jorge Santos Barbosa, Elisabete Correia, Sofia Antibiotics (Basel) Article Consumption of antimicrobials is an important driver of antimicrobial resistance. There is limited knowledge of the key determinants of antimicrobial prescribing behavior in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in Antimicrobial Stewardship Programs (ASP). This study aimed to describe the main factors that influence the doctor’s decision on antimicrobials prescribing and to identify the behaviors that drive physicians’ decision making. A structured web-based questionnaire focused on behavioral components of antimicrobial prescription was applied to the medical staff of three different departments—Internal Medicine, General Surgery, and Intensive Care Medicine—of a university hospital. All doctors agreed that inadequate use of antimicrobials increases AMR. A total of 77% of the surgeons and 100% of the internists and intensivists perceived antimicrobial prescription as a priority in the department. Full autonomy in antimicrobial prescription was preferred by internists (64%) but not by surgeons (18%) and intensivists (24%). Most physicians were keen to have ASP advice, but most did not want advice from colleagues of the same service. Almost all surgeons ask for advice when prescribing, but only 68% of the internists do it. Less than half of all physicians and only 25% of the surgeons felt free to prescribe contrary to guidelines. Most physicians, particularly in Intensive Care Medicine (94%), adopt the “wait and see” strategy when no microbiologic confirmation is available, but 27% of the surgeons start empirical therapy. In conclusion, the context of antimicrobial prescription, autonomy, and confidence in antimicrobial prescription demonstrated heterogeneity between the three departments and this should be considered when planning ASP. MDPI 2023-06-08 /pmc/articles/PMC10295435/ /pubmed/37370351 http://dx.doi.org/10.3390/antibiotics12061032 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Almeida-Costa, Ana Paula Muniz
Paiva, José-Artur
Almeida, António Jorge Santos
Barbosa, Elisabete
Correia, Sofia
Behavioral Components and Context of Antimicrobial Prescription in a Tertiary Hospital in Portugal
title Behavioral Components and Context of Antimicrobial Prescription in a Tertiary Hospital in Portugal
title_full Behavioral Components and Context of Antimicrobial Prescription in a Tertiary Hospital in Portugal
title_fullStr Behavioral Components and Context of Antimicrobial Prescription in a Tertiary Hospital in Portugal
title_full_unstemmed Behavioral Components and Context of Antimicrobial Prescription in a Tertiary Hospital in Portugal
title_short Behavioral Components and Context of Antimicrobial Prescription in a Tertiary Hospital in Portugal
title_sort behavioral components and context of antimicrobial prescription in a tertiary hospital in portugal
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10295435/
https://www.ncbi.nlm.nih.gov/pubmed/37370351
http://dx.doi.org/10.3390/antibiotics12061032
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