Exploring drivers and challenges influencing antibiotic prescribing in outpatient settings and possible mitigation strategies in the United Arab Emirates: a qualitative study.

Objectives: Healthcare institutions implement antimicrobial stewardship (AMS) programmes to optimize the use of antibiotics. The focus is often on inpatient rather than outpatient settings. We aimed to explore perceptions of AMS stakeholders on effective interventions for appropriate antibiotic use in outpatient settings, and the role of clinical pharmacists in the AMS multidisciplinary team. Methods: A qualitative semi-structured interview study using thematic analysis by two researchers independently. Participants that practice AMS programmes were recruited from healthcare facilities in the United Arab Emirates (UAE). Interviews were conducted face to face or online and transcribed verbatim. Results: Four themes emerged: (i) Perceived factors leading to unnecessary or inappropriate antibiotic prescribing and their impact on patients and the community; (ii) current outpatient AMS activities and perceived barriers and facilitators for their sustainability; (iii) suggested outpatient AMS strategies to be implemented in outpatient settings; and (iv) perceived future AMS implementation barriers and suggested mitigation strategies. Conclusions: Several AMS interventions, together with the presence of a clinical pharmacist, may be effective in improving antibiotic use in UAE outpatient settings. Future research should investigate the most appropriate AMS strategy considering barriers and possible mitigation strategies to ensure sustainability.

Factors Associated With Hospital Readmission of Heart Failure Patients.

Background: Heart failure (HF) is a significant cause of mortality, morbidity and impaired quality of life and is the leading cause of readmissions and hospitalization. This study aims to identify the factors contributing to readmission in patients with HF. Methods: A prospective-observational single-centre study was conducted in Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates. A total of 146 patients with HF are included in the study. Patient's demographics, patient medical characteristics, lab values, medications were collected for each patient, and the factors associated with readmission are identified. The primary outcome is to identify the factors contributing to readmission and reduce readmission rate. SPSS software for windows version 26 is used for data analysis. Results: The number of patients with heart failure admitted to hospital is higher with males (73.3%) than females. 42.1% were readmitted and were not compliant, whereas patients who are not readmitted and were compliant shows a lower percentage. Noncompliance was the most significant factor associated with readmission (p = 0.02, OR = 3.6, 95%CI: 1.57 - 8.28). Other factors that are associated with readmission were low haemoglobin (p = 0.001, OR = 0.96, 95%CI: 0.94 - 0.98), and NYHA class of HF (p = 0.023, OR = 2.22, 95%CI: 1.12 - 4.43). In addition, there are other factors that are linked with the disease but were not associated with readmission in our findings such as hypertension, coronary artery disease, gender, systolic blood pressure on admission, and age. Majority of the readmitted patients were NYHA Class IV 32/57 (56.1%) against 20/89 (22.7%) in non-readmission group. Length of stay is (Median ± IQR, 6 ± 8.5). Conclusion: The study has revealed that noncompliance, low haemoglobin and NYHA Class IV of HF were the main factors associated with readmission. Clinical pharmacist as a team member could help to improve adherence in order to reduce the rate of admission.