Barriers of Appropriate Antibiotic Prescription at PHCC in Qatar: Perspective of Physicians and Pharmacists

Abstract

The Ministry of Public Health in Qatar developed the NAP (National Action Plan to combat Antimicrobial Resistance (AMR) in collaboration with WHO Regional Office for the Eastern Mediterranean (WHO/EMRO). Among the major factors shaping AMR is antimicrobial prescribing and use. Tailoring Antimicrobial Resistance Program is a behavior change methodology that is utilized to adapt behavior change in relation to antimicrobial use. This study explores barriers of appropriate antibiotic (AB) prescription from the physicians’ and pharmacists’ perspectives at primary healthcare centers in Qatar. Data were collected from 50 participants across two PHCCs: 30 physicians and 20 pharmacists. Two different interview guides were constructed: One for physicians and one for pharmacists. In-depth, face-to-face, five focus groups were conducted and transcribed verbatim. Inductive qualitative analysis, involving discovering the themes in the interviews, was followed. Data were analyzed using constant comparative techniques. The Major themes arose from the analysis revealed that patients, practitioners mainly physicians, and the organization itself, played a role in shaping these barriers in the two primary healthcare centers. The findings would help develop and pilot behavior change interventions among patients, physicians and pharmacists with the aim of optimizing appropriate antibiotic prescription and use, which would support the implementation of the antibiotic stewardship program. Effective behavior change interventions should consider multiple factors including individual and organizational factors to optimize appropriate antibiotic prescription.

Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review

“…Additionally, diagnostic uncertainty is a leading driver of antibiotic prescribing To focus Antibiotic Stewardship Program efforts; research on the knowledge, attitudes, and beliefs influencing prescribing practices can be useful Karimi, et al [ 63 ] Study of experience, cultural and societal characteristics, and belief in the significant impact of antibiotic prescription. Self-medication, as well as the people's habits and cultural elements as a whole, encourage them to recommend doctors who frequently prescribe antibiotics There is a need to increase family doctors' knowledge and proficiency in prescription antibiotics in the primary healthcare setting Huang, et al [ 64 ] Diagnostic uncertainty and knowledge gaps, Organizational-related factors (organization norms and culture) were determinants of antibiotics prescribing practices Antibiotic prescribing can be made more effective by modelling institutional best practice standards and clinical decision support systems based on local epidemiology Sharaf, et al [ 65 ] Practitioners mainly physicians, patients and the organizations themselves played a role in shaping antibiotic uses and prescribing practice in primary healthcare centres. Patient’s behaviour, patient pressure, workload and restricted time of consultation and management response to patient complaints were strong factors of antibiotic prescribing practices Effective behavioural change initiatives should consider a variety of elements, including individual and organizational aspects Poss-Doering, et al [ 66 ] Continuity of care, patient expectations, uncertainty regarding diagnosis, prognosis, and when not knowing the patient are main factors in physicians' developed habits in decision-making on antibiotics prescribing No Liu, et al [ 67 ] Antimicrobial prescribing practices are complex processes and associated with external factors; financial incentives, patient pressure and time pressure) and intrinsic regarding prescriber (knowledge and attitude) It is crucial to implement policy initiatives that focus on external issues connected to the prescription of antibiotics Cordoba, et al [ 68 ] The variability of antibiotic prescription is explained by diagnostic uncertainty and contextual characteristics beyond clinical practice Providing physicians with evidence-based guidelines and tools to apply them …”

Antibiotic Stewardship: How It Is Implemented in Primary Healthcare Facility

“…The Ministry of Public Health in Qatar developed the NAP (National Plan of Action) to Fight Antimicrobial Resistance (AMR) in collaboration with the WHO Regional Office for the Eastern Mediterranean (WHO/EMRO)) [14]. Indonesia, through the Ministry of Health, has established rational drug prescription indicators for URTI and diarrhea at Public Health Centers.…”

“…In addition to the absence of a rapid diagnostic test, inappropriate application of guidelines, unavailability of specific antibiogram data, and the short consultation time due to many patients are also factors triggering the irrational use of antibiotics [14]. Public understanding of the dangers of antibiotic resistance plays an important role in controlling the spread of antibiotic resistance.…”

Antimicrobial Resistance in Qatar: Prevalence and Trends before and Amidst the COVID-19 Pandemic

“…Antibiotic administration is influenced by patient pressures, clinician knowledge, and laws and regulations [ 11 ]. In addition to the confusion associated with COVID-19, secondary bacterial infections and claims of the effectiveness of antibiotics such as azithromycin among COVID-19 patients have compounded the already worsening problem of antimicrobial resistance [ 12 ].…”