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  • Gruenberg, Katherine  (3)
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  • 1
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2019
    In:  Open Forum Infectious Diseases Vol. 6, No. Supplement_2 ( 2019-10-23), p. S883-S884
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. Supplement_2 ( 2019-10-23), p. S883-S884
    Abstract: Antimicrobial prescribing mistakes are common and adherence to guidelines for treatment of infections is poor. Effective use of clinical resources could help ameliorate these issues, but little is known about the use of such resources by physicians and pharmacists. We thus aimed to explore how practitioners utilize clinical resources in the management of infections. Methods We conducted individual interviews with a purposeful sample of eight Hospitalists, eight ID attendings, four ID pharmacists, and six non-ID pharmacists. As part of a larger, semi-structured interview exploring ID practice patterns, we asked respondents how they utilize resources when managing infections. We describe the resources mentioned by the different practitioners, as well as the frequency of their reported use. Results All respondents reported using at least one resource to help manage infections, with a mean of 5.6 resources each. The majority of respondents use resources daily, although some ID practitioners use resources more frequently and some general practitioners less frequently (Figure 1). The types of resources utilized by respondents fell into six main categories: local ID resources, outside ID resources, primary literature, guidelines, colleagues, and pharmacy resources (Figure 2). In general, local resources are utilized more frequently by non-ID practitioners, while guidelines and the primary literature are utilized more frequently by ID practitioners. ID physicians use pharmacy resources more frequently than non-ID physicians. Six respondents spontaneously reported being motivated to review resources for their own interest or learning. Several also commented that accessibility was important in choosing resources. Conclusion Providers report use of resources to manage infections, although the type of resource and frequency of use varies. ID practitioners utilize more detailed resources than nonspecialists. Accessibility seems to influence resource utilization, which may explain the popularity of local ID resources. As such, efforts to make local ID resources as accessible and clear as possible may have an impact on appropriate antibiotic use. Future quantitative studies could help illuminate rates and perceived advantages of specific resource utilization. Disclosures All authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2757767-3
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  • 2
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S595-S596
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S595-S596
    Abstract: Relative to the study of diagnostic reasoning, less is known about how clinicians make therapeutic decisions. Past work has explored how physicians choose particular antimicrobials in specific cases (antimicrobial therapeutic reasoning - ATR), but how pharmacists make similar determinations has remained unexplored. Understanding ATR by pharmacists could inform pharmacist education and improve antimicrobial stewardship (AS). Methods We conducted individual interviews with a purposeful sample of 11 pharmacists (5 ID specialist pharmacists and 6 non-specialists), adapting a protocol for semi-structured interviews utilizing clinical vignettes based on a prior study in physicians. In addition, participants were asked to describe their ATR process generally using a novel notecard exercise. Interviews were transcribed and analyzed with Dedoose, using the prior study’s codebook as an initial framework and adding and adapting codes through an iterative process. Results We found that pharmacists generally engage in the same major ATR steps (Naming the Syndrome, Delineating Pathogens, Selecting the Antimicrobial) previously described in physicians (Figure 1). Pharmacists also seemed to incorporate similar patient- and system-factors and to utilize “therapy scripts”. However, specific factors and therapy script categories did not overlap completely, with some new factors and nuances emerging (Table 1). Overall, the antimicrobial reasoning framework described for physicians encompassed pharmacists’ AR, but some pharmacists described “Revisiting the Syndrome” in light of the clinical data and in some cases pharmacists appeared to filter script options (for example, due to allergies) before proceeding. Figure 1 - Antimicrobial Therapeutic Reasoning Framework Table 1 - Factors Involved in Pharmacists’ Antimicrobial Reasoning Process Conclusion The framework describing pharmacist antimicrobial ATR and is similar to that in a prior study of physicians, with some nuances that may be attributable to the pharmacist’s reviewer role in AS. Application of this framework has potential to aid in teaching learners, identifying where error or bias may occur, improving multidisciplinary AS efforts, and providing a common framework for communication. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2757767-3
    Location Call Number Limitation Availability
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  • 3
    Online Resource
    Online Resource
    Wiley ; 2022
    In:  JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY Vol. 5, No. 4 ( 2022-04), p. 398-405
    In: JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY, Wiley, Vol. 5, No. 4 ( 2022-04), p. 398-405
    Abstract: Clinicians engage in clinical reasoning, comprised of both diagnostic and therapeutic components, when caring for patients. While diagnostic reasoning has been extensively investigated, relatively few studies have examined how clinicians make treatment decisions. Recent work has explored how physicians engage in therapeutic reasoning while selecting antimicrobials. However, understanding pharmacists' antimicrobial reasoning is equally important due to their role in ensuring appropriate antimicrobial use. Therefore, we aimed to further our understanding of antimicrobial reasoning in pharmacists and compare their reasoning processes to physicians. METHODS With a postpositivist orientation and using a general qualitative approach, we conducted semi‐structured interviews with hospital‐based pharmacists specializing in infectious diseases or other hospital‐based specialties. Participants narrated their thought processes while selecting antimicrobials for three case vignettes. We analyzed transcripts iteratively using a code book from a prior study of antimicrobial reasoning in physicians as a sensitizing framework. RESULTS Participants included 11 pharmacists (5 infectious diseases and 6 noninfectious diseases pharmacists). Overall, participants' responses reflected a three‐step reasoning process: Naming the Syndrome , Delineating Pathogens , and Selecting the Antimicrobial . Patient‐, syndrome‐, and system‐based factors interacted with drug characteristics to influence the selection of specific antimicrobial regimens. CONCLUSION We identified a framework for pharmacists' antimicrobial therapeutic reasoning similar to physicians' reasoning, with some nuances that may be attributable to the pharmacists' role in medication review and antimicrobial stewardship. Application of this framework has the potential to aid in teaching, improve multidisciplinary care, and provide a framework for interprofessional communication.
    Type of Medium: Online Resource
    ISSN: 2574-9870 , 2574-9870
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2920371-5
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