Attitudes of pharmacists and physicians to antibiotic policies in hospitals

BACKGROUND: Antibiotic therapy in hospitals has substantial impact on patient outcome and the pharmacy drug budget. Antibiotic policies have been implemented by some hospitals to improve the quality of patient outcome and cost of antibiotic therapy. Antibiotic policies impose certain requirements on pharmacists and physicians. Pharmacists' and physicians' attitudes to and opinions about antibiotic policies are likely to affect the usefulness of such policies. AIM: To determine the attitudes of pharmacists and physicians to antibiotic policies in New South Wales (NSW) hospitals. METHODS: Pharmacists and physicians in NSW public hospitals were surveyed to determine their attitudes to and opinions on antibiotic policies. A simple one-stage cluster sample of 241 pharmacists and a two-stage cluster sample of 701 physicians were obtained. Factor analysis was used to identify the attitudinal dimensions. General linear modelling was used to investigate the effects of predictor variables on outcome variables. RESULTS: The response rates were 91% and 77% for pharmacists and physicians, respectively. Factor analysis identified three dimensions of attitude to antibiotic policies: that they encourage rational antibiotic use; that they improve the quality of antibiotic prescribing and that they are associated with some problems. The reliability of these factors (Cronbach's alpha) ranged from 0.71 to 0.74, and was 0.90 for the overall attitude scale. Pharmacists and physicians had a positive overall attitude to antibiotic policies. Whereas physicians recognize that antibiotic policies improve the quality of prescribing, this was highly correlated with identification of problems (alpha = 0.71). In urban hospitals, pharmacists were more likely than physicians to associate antibiotics with problems. CONCLUSION: There was a positive overall attitude to hospital antibiotic policies expressed by pharmacists and physicians.     

我院住院医嘱中不合理用药问题的调查分析

目的:促进临床合理用药。方法:随机抽取我院2003~2004年住院医嘱,根据药品说明书、国内外文献资料及临床药理学知识,对不合理用药的医嘱进行统计分析。结果:不合理用药医嘱占全部抽查医嘱的6.43%,其中占比例最大的属抗生素的不合理应用,占全部不合格医嘱的82.27%。不合理用药主要表现在联合用药不当、重复性给药、给药时间不当、给药剂量过大或过小、缓控释制剂使用不合理等方面。结论:医院药房调剂工作中的审核行为是药学服务的有效措施,应充分发挥临床药师的作用,进一步促进临床合理用药。     

38家基层及民办医疗机构门诊抗菌药物合理应用现状分析

[目的]调查基层及民办医疗机构门诊处方抗菌药物合理应用情况,为执行抗菌药物管理政策做参考.[方法]对38家基层及民办医疗机构2013年11月至2014年1月期间抗菌药物临床使用情况进行随机抽样调查,分析所调查的8000张处方抗菌药物的使用情况并剖析问题的成因.[结果]8 000张处方中,不合理使用抗菌药物占33.68％,38家基层及民办医疗机构抗菌药物临床应用中存在不同程度遴选、联用、用法用量的不适宜,抗菌药物不合理应用比例较高等问题,而以民营医院问题更为严重.[结论]必须加强基层及民办医疗机构抗菌药物合理应用的管理,以节约医疗资源,抵御细菌耐药性.     

PRESCRIBING PATTERN IN A DUTCH UNIVERSITY HOSPITAL

In many countries, including The Netherlands, little is known about the overall prescribing patterns within hospitals. While individual hospitals have some data available, these are not pooled on a regional or national level. The available data consist of dispensing data that are neither patient-linked nor diagnosis-linked. We report the results of a study in a Dutch university hospital which show that despite the limitations, such data can be used for a general evaluation of prescribing patterns. Using three categories of undesirable or irrational drug prescribing the dispensing data were screened. The categories were 'inferior or dubious' drugs, 'semi-innovative' drugs, and 'inappropriately used' drugs. The results show that most problems are seen with the use of new drugs. In the first instance, this involves the use of semi-innovative drugs whose adoption may be stimulated by clinical trials in the hospital concerned. Secondly, innovative drugs seem to be used on too large a scale, i.e., for indications for which their use is not warranted. Based on these findings, a follow-up study has been initiated to study some of these suboptimal drug choices in detail.     

Family Practitioners and the Prescription of Psychoactive Drugs

Sixty-eight family physicians in Toronto were personally interviewed and reported the drugs they prescribed for a list of functional ailments, estimated extent of their per-patient prescribing of psychoactive drugs, also their attitudes toward emotionally disturbed or neurotic patients. Numerous variables were explored, but the only important correlation with lower prescribing rates was the period of graduation (1955 or later), irrespective of the patient population composition. Attitudes toward neurotics had no connection with per-patient prescribing, older graduates holding as favorable attitudes as more recent ones. An unfavorable attitude did, however, correlate with a greater number of patients seen on an average day. Background characteristics, professional associations and types of practices are described. Some irrational elements in prescribing are discussed.     

Physicians’ knowledge,perceptions and behaviour towards antibiotic prescribing: a systematic review of the literature

Background: Knowledge, perceptions and prescribing behaviour are key to antibiotic prescribing. The aim of this paper is to systematically review this. Method: An extensive literature search from 1990 to 2014. Results: Nineteen articles were included; eight in ambulatory care, seven in hospital settings and four in both, across all countries. Physicians still have inadequate knowledge and misconceptions about antibiotic prescribing. Moreover, some physicians, although aware that antibiotics are of limited benefit in some conditions, still prescribed them. Several factors influenced prescribing, including patients’ expectations, severity and duration of infections, uncertainty over diagnosis, potentially losing patients and influence of pharmaceutical companies. Pocket-sized guidelines seen as an important source of information for physicians. Conclusion: Inadequate knowledge of prescribing is prevalent among physicians. However, many physicians were interested in improving their antibiotic prescribing. Multifaceted interventions targeting all key stakeholders, including patients, are needed to improve future antibiotic prescribing.     

Interprofessional pharmacotherapy workshop: intervention to improve health professionals’ and students’ attitudes towards collaboration between physicians and pharmacists

ABSTRACT

Collaboration between physicians and pharmacists is recognized as an important factor for reducing medication errors and improving patient outcomes. Therefore, two pharmacotherapy workshops were delivered in Croatia - one for pre-registration medical (n=42, 4th-6th year) and pharmacy (n=38, 4th-5th year) students, and the other one for physicians (n=18) and pharmacists (n=23). The purpose of this study was to determine whether participation in common pharmacotherapy workshop could improve attitudes among participants towards interprofessional collaboration between pharmacists and physicians. Attitudes were measured by validated questionnaire “Scale of Attitudes Towards Collaboration Between Pharmacists and Physicians” at the beginning and at the end of the workshops. Three complex clinical scenarios were presented during the workshops. Participants were given general information about cases (all participants) and 2 groups of specific information (only for medical students/physicians and only for pharmacy students/pharmacists). For the first scenario, medical and pharmacy students/professionals were not allowed to exchange their specific information. However, participants collaborated for the 2nd and 3rd scenarios in order to achieve the hypothesized therapeutic goals. Before the workshops, pharmacists and pharmacy students showed more positive attitudes than physicians and medical students. However, the workshop contributed in closing the gap by equating health care professionals’ attitudes. Additionally, students’ attitudes were more positive after the workshop with an increase of 10% for medical and 2.2% for pharmacy students. This study indicates that interprofessional pharmacotherapy workshops could significantly improve attitudes toward collaboration between physicians and pharmacists for both students and practicing professionals.     

Physicians' knowledge and attitudes toward the use of analgesics for cancer pain management: a survey of two medical centers in Taiwan

The purposes of this study were to examine the attitudes of physicians regarding the optimal use of analgesics for cancer pain management (CPM), to evaluate their knowledge and attitudes toward opioid prescribing, and to comprehend their perceptions of the barriers to optimal CPM. A survey was conducted on 356 physicians with cancer patient care responsibilities practicing in two medical centers in Taiwan. A total of 204 (57%) physicians responded, including internists (28%), surgeons (27%), oncologists (11%), anesthesiologists (10%), and other specialties (24%). The majority of physicians displayed significantly inadequate knowledge and negative attitudes toward the optimal use of analgesics and opioid prescribing. Multivariate analyses showed that the following six categories of physicians would be inclined to have inadequate knowledge of opioid prescribing: 1) those with perception of good medical school training in CPM, 2) those with perception of poor residency or fellowship training in CPM, 3) those with a medical specialty in surgery, medicine, or oncology (vs. anesthesiology), 4) those with limited clinical experience in cancer patient care (number of patients less than 30), 5) those with a limited aim of pain relief, and 6) those with an underestimation of analgesic effect. Additionally, physicians with inadequate knowledge of opioid prescribing and with hesitation to intervene earlier with maximal dose of analgesia would be inclined to have reluctant attitudes toward opioid prescribing. The most important barriers to optimal CPM identified by physicians themselves were physician-related problems, such as inadequate guidance from a pain specialist, inadequate knowledge of CPM, and inadequate pain assessment. The results of this study suggest that active analgesic education programs are urgently needed in Taiwan.     

临床药师对Ⅰ类切口手术预防用抗菌药物干预效果分析

目的 验证临床药师对外科预防使用抗菌药物进行干预的效果,方法以临床药师督查记录数据为基础,将2010年1-3月238份病历设为非干预组,2010年10-12月240份病历设为干预组,建立评价标准,进行回顾性汇总、分析.结果 通过干预,抗菌药物使用率从干预前的100%下降为77.08%(x2=63.633,P=0.000...