Indonesian Healthcare Providers’ Perceptions and Attitude on Antimicrobial Resistance, Prescription and Stewardship Programs

Abstract

Background: A successful antimicrobial stewardship program (ASP) is sustained through improving antimicrobial prescribing by changing prescribing behavior. This requires a better understanding of hospital stakeholders’ views regarding antimicrobial resistance (AMR), antimicrobial use and participation in ASP activities. Objectives: Identify perceptions and attitudes among physicians and pharmacists in a public hospital toward AMR, prescription and ASP. Methods: A questionnaire consisting of 45 items was distributed to physicians and pharmacists in a 320-bed public hospital. All responses were formatted into the Likert scale. Results: A total of 78 respondents (73% response rate) completed the questionnaire. The majority of the respondents perceived AMR within hospital as less of a severe problem, and factors outside hospital were considered to be greater contributors to AMR. In addition, interprofessional conflict was identified as a serious concern in relation to implementing ASP. Conclusion: This finding indicates the need to address existing perceptions and attitudes toward ASP activities that may hamper its successful implementation in Indonesia.

Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review

“…Eleven studies each identified the absence of leadership and minimal governmental support [ 27 , 28 , 35 – 42 ], and a lack of reliable laboratory infrastructure and microbiology laboratory support as challenges to effective ASP implementation [ 28 , 29 , 31 , 35 , 36 , 38 , 40 , 42 – 45 ]. Other identified barriers included inadequate orientation and training on ASP including rational antimicrobial use [ 27 , 30 , 36 , 41 , 44 , 46 ], prescribers’ negative attitudes to changes in antibiotic practices [ 27 , 30 , 33 , 35 , 37 , 43 , 47 ], and a lack of dedicated ASP funds [ 28 , 32 , 33 , 36 , 37 , 41 ]. Five studies each cited the absence of approved national guidelines or educational programs [ 27 , 36 , 43 , 45 , 48 ], and time constraints for prescribers [ 28 , 30 , 36 , 41 , 48 ] as barriers.…”

“…Six of these studies (29%, 6/21) reported on all three elements: knowledge, attitude, and practice [ 27 , 45 , 47 , 50 – 52 ], and six others exclusively assessed ASP practice compliance [ 32 , 53 – 57 ]. The majority of the studies revealed that prescribers (physicians or pharmacists) had a sub-optimal knowledge of ASP and its basic principles [ 31 , 45 , 47 , 51 , 52 , 58 ]. However, four studies stated that prescribers had sufficient knowledge of the correct antibiotic indication (i.e.…”

“…In terms of attitude towards ASP implementation, the majority of prescribers showed positive attitudes, as they felt ASP is beneficial for both prescribers and patients [ 27 , 29 , 31 , 45 , 49 , 51 , 52 , 60 , 61 ], and were interested receive feedback on their antibiotic prescriptions [ 27 , 31 , 45 , 52 ]. However, some studies also revealed the physicians’ concern that implementation of ASP would limit their prescribing autonomy [ 47 , 50 , 52 ]. Regarding ASP practice, studies reported that prescribers mostly had a substandard level of involvement in ASP activities or previously worked in ASP facilities [ 44 , 45 , 51 , 52 , 56 ].…”

“…Our review revealed that prescribers were on board to receive regular monitoring and feedback on rational antibiotic use and recommended tailored ASP training [ 27 , 45 , 52 , 61 ]. However, a few studies also revealed that physicians were concerned that ASP implementation might lead to a loss in their prescribing autonomy [ 27 , 47 , 52 ]. Despite the overall favorable perceptions, most countries have yet to align with global efforts to combat increasing AMR through stewardship activities.…”

Assessment of Physicians’ Practice in Implementing Antibiotic Stewardship Program in Najran City, Saudi Arabia: A Cross-Sectional Study

“…ASPs often establish a restricted formulary, which limits the available antibiotic options for physicians. They may need to adhere to specific guidelines and protocols when selecting antibiotics, restricting their freedom to prescribe broader-spectrum or newer antibiotics [9].…”