Investigating clinicians' determinants of antimicrobial prescribing behaviour using the Theoretical Domains Framework.

AIM: To identify and quantify potential determinants of antimicrobial prescribing behaviour, using the Theoretical Domains Framework (TDF). METHODS: A cross-sectional survey involving doctors (∼4000) and pharmacists (∼400) working within Hamad Medical Corporation (HMC), Qatar. An online questionnaire, developed with reference to the TDF, included: personal and practice demographics, and Likert statements on potential determinants of antimicrobial prescribing practice. Analysis included principal component analysis (PCA), descriptive and inferential statistics. RESULTS: In total, 535 responses were received, 339 (63.4%) from doctors. Respondents were predominantly male, 346 (64.7%). Just over half (N = 285, 53.3%) had ≤5 years' experience. PCA showed a three-component (C) solution: 'Guidelines compliance' (C1), 'Influences on practice' (C2) and 'Self-efficacy' (C3). The scales derived for each component had high internal consistency (Cronbach's alphas >0.7), indicating statistical appropriateness for developing scales. Respondents generally scored highly for 'Guidelines compliance' and 'Self-efficacy'. The lowest levels of positive scores were in relation to the items within the 'Influences on practice' component, with particular focus on TDF domains, environmental context and resources, and social influences. Inferential analysis comparing component scores across demographic characteristics showed that doctors, the more qualified and those with greater experience, were more likely to be positive in responses. CONCLUSIONS: This study has identified that environmental context and resources, and social influences, with an emphasis on pharmacists and early career clinicians, may be useful targets for behaviour change interventions to improve clinicians' antimicrobial prescribing, thereby reducing antimicrobial resistance rates. Such interventions should focus on appropriate linked behaviour-change techniques.

Study of the significance of percentage of peripheral CD4+ & CD8+ T cells and the hepatitis C virus genotypes in Egyptian patients with chronic hepatitis C.

Sequence comparison between isolates of hepatitis C virus (HCV) indicated that HCV can be classified into a series of distinct genotypes. The aim of this study was to determine the prevalence and clinical significance of HCV genotypes, to evaluate clinical relevance of percentage of CD4+ and CD8+ T cells in blood, and to find out predictors of response to interferon (IFN) therapy in Egyptian chronic hepatitis C (CHC) patients. The present study included 61 CHC patients who were subjected to HCV-RNA detection, HCV genotyping, and determination of percentage of CD4+ and CD8+ T cells in blood before and after six months treatment with IFN. Also, 20 healthy adults were enrolled as control group. Results revealed that genotype 4a is the prevalent HCV-genotype (85%) in Egypt. Only 21% of cases responded to IFN. The percentage of CD4+ T cells was significantly reduced, while the percentage of CD8+ T cells was significantly increased in patients with CHC. After IFN therapy only the percentage of CD8+ T cells was significantly reduced in non responders. Both genotype and percentage of both CD4+ and CD8+ T cells failed to predict response to IFN. It was concluded that genotype 4a is the predominant genotype in Egypt. CHC is a disease of liver which may be induced by a suboptimal immune response. Selection of CHC patients for treatment with IFN is still a controversial issue.