Prescribing under pressure: Institutional barriers to stewardship among clinicians of different specialties in Saudi Arabia

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2025-07-01 DOI:10.1016/j.cegh.2025.102117

Israa Abdullah Malli , Jawahir Omar AlTamimi

{"title":"Prescribing under pressure: Institutional barriers to stewardship among clinicians of different specialties in Saudi Arabia","authors":"Israa Abdullah Malli , Jawahir Omar AlTamimi","doi":"10.1016/j.cegh.2025.102117","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate clinicians’ antibiotic stewardship knowledge, prescribing behaviors, and opinions and identify demographic and institutional factors influencing stewardship effectiveness.</div></div><div><h3>Study design</h3><div>Mixed-methods.</div></div><div><h3>Methods</h3><div>We used a validated questionnaire and focus group interviews to gather data from 116 clinicians. Qualitative analysis explored institutional and experiential barriers, whereas quantitative analysis examined associations between stewardship knowledge and clinician characteristics.</div></div><div><h3>Results</h3><div>Significant associations were found between stewardship knowledge and age (p = 0.0092), gender (p = 0.0045), and years of experience (p = 0.0460). Pediatricians demonstrated higher stewardship knowledge than family physicians (p = 0.0106). Focus group discussions revealed institutional barriers including time constraints, lack of monitoring mechanisms, and diagnostic uncertainty. One participant noted, “It's safer to prescribe antibiotics just in case, rather than risk a patient developing a severe infection.”</div></div><div><h3>Conclusions</h3><div>Clinicians face both personal and institutional challenges in applying stewardship principles. We need local standards to reduce multidrug resistance; thus, targeted continuing medical education, structured case-based training, public awareness campaigns, and improved access to rapid diagnostics may enhance the effectiveness of antimicrobial stewardship programs across specialties.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"34 ","pages":"Article 102117"},"PeriodicalIF":1.7000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Epidemiology and Global Health","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213398425002064","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

To evaluate clinicians’ antibiotic stewardship knowledge, prescribing behaviors, and opinions and identify demographic and institutional factors influencing stewardship effectiveness.

Study design

Mixed-methods.

Methods

We used a validated questionnaire and focus group interviews to gather data from 116 clinicians. Qualitative analysis explored institutional and experiential barriers, whereas quantitative analysis examined associations between stewardship knowledge and clinician characteristics.

Results

Significant associations were found between stewardship knowledge and age (p = 0.0092), gender (p = 0.0045), and years of experience (p = 0.0460). Pediatricians demonstrated higher stewardship knowledge than family physicians (p = 0.0106). Focus group discussions revealed institutional barriers including time constraints, lack of monitoring mechanisms, and diagnostic uncertainty. One participant noted, “It's safer to prescribe antibiotics just in case, rather than risk a patient developing a severe infection.”

Conclusions

Clinicians face both personal and institutional challenges in applying stewardship principles. We need local standards to reduce multidrug resistance; thus, targeted continuing medical education, structured case-based training, public awareness campaigns, and improved access to rapid diagnostics may enhance the effectiveness of antimicrobial stewardship programs across specialties.

查看原文本刊更多论文

压力下的处方：在沙特阿拉伯不同专业的临床医生之间管理的制度障碍

目的评估临床医生的抗生素管理知识、处方行为和意见，确定影响抗生素管理有效性的人口统计学和制度因素。研究designMixed-methods。方法采用问卷调查法和焦点小组访谈法，对116名临床医生进行资料收集。定性分析探讨了制度和经验障碍，而定量分析考察了管理知识和临床医生特征之间的联系。结果管理知识与年龄（p = 0.0092）、性别（p = 0.0045）、工作年限（p = 0.0460）存在显著相关。儿科医生的管理知识水平高于家庭医生（p = 0.0106）。焦点小组讨论揭示了制度障碍，包括时间限制、缺乏监测机制和诊断不确定性。一位参与者指出，“开抗生素以防万一更安全，而不是冒着病人严重感染的风险。”结论临床医生在应用管理原则时面临个人和机构的双重挑战。我们需要地方标准来减少多药耐药性；因此，有针对性的继续医学教育、有组织的基于病例的培训、提高公众意识的运动以及改善快速诊断的可及性可能会提高跨专业抗菌剂管理方案的有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.