Evaluation of knowledge, awareness, and practice of antimicrobial stewardship among prescribers of a teaching hospital in South India

Background: The injudicious and indiscriminate use of antimicrobials has led to the development of antimicrobial resistance (AMR), particularly in the low- and middle-income countries. Antimicrobial Stewardship (AMS) is the coordinated intervention to enhance the appropriate use of antimicrobials. Antimicrobial stewardship program (ASP) is a multidisciplinary program with interventions and strategies to encourage AMS to prevent emergence of AMR. Aims and Objectives: This study aimed at evaluating the knowledge, awareness, and practice (KAP) of AMS among prescribers of a teaching hospital in South India. Materials and Methods: A cross-sectional questionnaire based study conducted after obtaining Institutional Ethics Committee approval was conducted among prescribers of a teaching hospital from September 2022 to October 2022. Responses to the questionnaires issued to the prescribers through Google Forms were analyzed by descriptive statistics using Microsoft excel. Results: A total of 230 prescribers submitted the filled in questionnaires. The definition of AMS was known to 62%. The constitution and functioning of ASP was known to 59%. However, only a few (38%) prescribers agreed that antimicrobials are avoided in viral infections. More than 60% had good awareness of AMS. However, only 25% were aware of an ASP program is their hospital. Fifty percent agreed to the practice of reviewing antimicrobial use after 48–72 h and only 38% to the practice of obtaining cultures before prescribing antimicrobials. Conclusions: The prescribers had moderate knowledge and awareness and poor practice of AMS. To address these gaps, educational interventions and capacity building approaches are required.

Perceptions and Attitudes of Hospital' Prescribers towards Drug Information Sources and Prescribing Practices

Abstract Healthcare professionals use a variety of drug information sources to fulfill their clinical needs and medical practice. The aim of present study was to assess the sources of drug information among hospital' prescribers and evaluate their prescribing behavior in Saudi hospitals. A cross-sectional survey was conducted among randomly selected hospital' prescribers using a self-administered questionnaire. The response rate to the survey was 64.29%, with a ratio of 76.44% male and 23.56% female. The internet 137(60.89%) and textbooks 86(38.22%) were the prevalent sources for drug information used. Up-To-Date 107(47.56%), Medscape 105(46.67%) and FDA 74(32.88%) were the common electronic drug sources used. About 151(67.11%) of hospital' prescribers considered the pharmacist as a reliable drug information source. The most favored drug requests by hospital' prescribers from the pharmacists were drug alternatives 110(48.89%) followed by drug interactions 94(41.78%), side effects 78(34.67%) and indications 60(26.67%). Therapeutic efficacy 168(74.67%) and drug availability 73(32.44%) were the main factors contributed to the selection of drugs. This study shows some differences in hospital prescribers' perceptions of sources of drug information depending upon their background and clinical practice. Therefore, knowing appropriate drug information used by hospital' prescribers is fundamental for drug efficacy and safety in clinical practice.

Prescripción de ciprofloxacino por vía parenteral en pacientes ingresados en los servicios de Medicina Interna y Caumatología de un hospital general / Parenteral prescription of ciprofloxacin in patients admitted to the Internal Medicine and Caumatology services of a general hospital

Se realizó un estudio observacional descriptivo y transversal de 76 pacientes ingresados en los servicios de Medicina Interna y Caumatología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba durante el 2012, para evaluar los conocimientos, el desempeño y la satisfacción de 22 profesionales que prescribieron ciprofloxacino por vía parental. Los conocimientos y la satisfacción fueron evaluados a través de un examen de conocimientos y una encuesta de satisfacción, respectivamente; el desempeño, a partir de la información obtenida de las historias clínicas, relacionadas con tres criterios: individualización del tratamiento, esquema terapéutico y combinaciones medicamentosas. Para cada criterio se establecieron indicadores y estándares. Los prescriptores presentaron conocimientos adecuados sobre el medicamento en cuestión; sin embargo, el desempeño y la satisfacción de estos resultaron inadecuados. Se considera necesario realizar una intervención en aras de revertir las deficiencias identificadas y contribuir a elevar la calidad de la prescripción de medicamentos en ambos servicios de salud

A descriptive, cross-sectional and observational study of 76 patients admitted to the Internal Medicine and Caumatology services of Dr Juan Bruno Zayas Alfonso Teaching General Hospital was carried out in Santiago de Cuba during 2012, to evaluate the knowledge, performance and satisfaction of 22 professionals who prescribed parental ciprofloxacin. The knowledge and satisfaction were evaluated through a knowledge examination and a survey of satisfaction, respectively; the performance was evaluated, starting from the information obtained from the medical records, related to 3 criteria: individualization of the treatment, therapeutic schedule and medication combinations. For each opinion, indicators and standards were established. The prescribers presented appropriate knowledge on the specific medication; however, the performance and satisfaction of them were inadequate. It is necessary to carry out an intervention to revert the identified deficiencies and contribute to elevate the quality of the medications prescription in both health services

Comprehensive medication management services influence medication adherence among Japanese older people / Journal of Rural Medicine

<b>Objective:</b> Assistance from health professionals is very important to ensure medication adherence among older people. The present study aimed to assess the relationship between receipt of comprehensive medication management services by primary care physicians and medication adherence among community-dwelling older people in rural Japan.<b>Methods:</b> Data including medication adherence and whether or not a doctor knew all the kinds of medicines being taken were obtained from individuals aged 65 years or older who underwent an annual health checkup between February 2013 and March 2014 at a public clinic in Asakura. The subjects were divided into 2 groups: adherent (always) and non-adherent (not always). A logistic regression analysis was performed to assess the association between the presence of a doctor who was fully responsible for medication adherence and self-reported adherence. Predictors that exhibited significant association (<i>p-</i>value < 0.05) with medication adherence in a univariate analysis were entered in the model as possible confounding factors. The results were presented as odds ratios (OR) and 95% confidence intervals (CI).<b>Results:</b> Among four-hundred ninety-seven subjects in total, the adherent group included 430 subjects (86.5%), and its members were older than those of the non-adherent group. Significant predictors of good medication adherence included older age, no discomforting symptoms, eating regularly, diabetes mellitus and having a doctor who knew all the kinds of medicines being taken. After being adjusted for confounding variables, the subjects with a doctor who knew all the kinds of medicines they were taking were three times more likely to be adherent to medication (OR 3.01, 95% CI 1.44-6.99).<b>Conclusion:</b> Receipt of comprehensive medication management services for older people was associated with medication adherence.

Guideline adherence and control of diabetes mellitus with or without co-morbidities in various wards of a tertiary hospital in Malaysia.

To assess the adherence of physicians involved in the management of diabetes mellitus with or without co-morbidities with reference to Clinical Practice Guideline 2009 given by Ministry of Health Malaysia in the tertiary care hospital, Pinang General Hospital Malaysia. Cross-sectional study was done at tertiary care hospital, Penang, Malaysia. The total 51 physicians and 1020 patient’s prescriptions written by same physicians were taken from the record of the Penang General Hospital (20 prescriptions for each enrolled physician). All 1020 patients were suffering from diabetes mellitus with or without co-morbidities. These patients were recruited from the different wards of the Penang General Hospital. Depending on the recommendations of CPG 2009 the prescriptions of patients were divided into adherent and non-adherent prescriptions. The overall good level of physician adherence was seen with respect to the recommendations of CPG 2009 in all prescriptions. A statistically significant negative association (Ф= 0.094, p-value=0.003) was observed between diabetes mellitus control and co-morbidities. CPG adherent had statistically weak negative association (Ф= -0.081, p-value=0.010) with patients having co-morbidities. No statistically significant association was observed between CPG adherence and any other co-morbidity. The study explored the several features of prescription pattern of physicians involved in the management of diabetes mellitus with or without co-morbidities and recognized the need for improvement in their prescription pattern for treating the diabetes mellitus.

Guideline adherence and control of diabetes mellitus with or without co-morbidities in various wards of a tertiary hospital Malaysia.

To assess the adherence of physicians involved in the management of diabetes mellitus with or without co-morbidities with reference to Clinical Practice Guideline 2009given by Ministry of Health Malaysia in the tertiary care hospital, Pinang General Hospital Malaysia. Cross-sectional study was done at tertiary care hospital, Penang, Malaysia. The total 51physicians and 1020 patient’s prescriptions written by same physicians were taken from the record of the Penang General Hospital (20 prescriptions for each enrolled physician). All 1020 patients were suffering from diabetes mellitus with or without co-morbidities. These patients were recruited from the different wards of the Penang General Hospital. Depending on the recommendations of CPG 2009 the prescrip-tions of patients were divided into adherent and non-adherent prescriptions. The overall good level of physician adherence was seen with respect to the recommendations of CPG2009 in all prescriptions. A statistically significant negative association (Ф= 0.094, p-value=0.003) was observed between diabetes mellitus control and co-morbidities. CPG adherent had statistically weak negative association (Ф= - 0.081, p-value=0.010) with patients having co-morbidities. No statistically significant association was observed between CPG adherence and any other co-morbidity. The study explored the several features of prescription pattern of physicians involved in the management of diabetes mellitus with or without co-morbidities and recognized the need for improvement in their prescription pattern for treating the diabetes mellitus.

An Analysis and Comparison of Commonly Available Prescribing Information Resources in North Indian Set Up.

To determine the prescribing information resources and the types of information about new drugs that Indian doctors perceived as important before prescribing and how they keep their information upto date . Also to determine if hospital doctors and General practitioners differed in their use of the sources. Two hundred general practitioners (GPs) and 200 hospital doctors were asked to rate information sources in terms of their importance for prescribing ‘old’ and ‘new’ drugs, and then to name the source from which information about the last new drug prescribed was actually derived. The study was carried out by information collection, by filling a questionnaire. Among 200 GPs, the Monthly Index of Medical Specialties (MIMS), pharmaceutical representatives and medical journal articles were most frequently rated as important for information on both old and new drugs . Among 200 hospital doctors, Refreshers courses by Govt.(Trainings),Monthly Index of Medical Specialties (MIMS) , and Hospital clinical meetings were of greatest importance. Information on the last new drug prescribed was derived from a broad range of sources. GPs and hospital doctors differ in their utilization of the prescribing information resources .This study generates the information that can be sought to help in shaping the development of health policy and the implementation of the Primary Health Care Strategy.