Specialty (if any): Internal Medicine & Family Medicine     

Keywords: Challenges in antibiotic prescription, prevent/mitigate antibacterial resistance, and unhouse/shelters.

Background: This project continues the Antimicrobial Stewardship in Outreach Clinics in Tijuana project conducted by Xochitl Longstaff. Longstaff's study showed that providers struggled with the Antimicrobial Stewardship form, an essential tool for monitoring antibiotic prescriptions at mobile clinics. The forms were not completed accurately, which raised questions about the form's significance and potential barriers to its accurate completion. One of the goals of our study was to understand whether providers were having difficulties with the form itself or if other barriers prevented them from completing it accurately. Our study also aimed to determine the problems providers faced when prescribing antibiotics in atypical settings, implement changes accordingly, and identify ways to prevent or mitigate antibiotic resistance. Extensive research has been done on antibiotic resistance in migrants in Europe and some in Asia. However, few studies have been done on antibiotic resistance in migrant and unhouse populations in North and Central America. Our study will inform the challenges that providers are facing when prescribing antibiotics in atypical settings and potential solutions that might decrease antibiotic resistance in migrant communities in Tijuana, Mexico.

Objective: Determine provider perspectives and challenges when prescribing antibiotics, how to prevent and mitigate antibiotic resistance, and identify areas for quality improvement at the Refugee Health Alliance (RHA).

Methods: This is a qualitative study that uses both convenience and purposive sampling. We conducted in-depth interviews with providers from different medical and specialty training backgrounds who had provided medical care at the RHA clinic and outreach shelter clinics. The interviews were conducted in English and Spanish, in person or via video conference. We used AI to transcribe the interviews. Our data will be analyzed using ATLAS.

Results: We are still in our data-collection phase, and the data presented in this abstract are from the first five interviews. Our preliminary data shows that 60% of providers agree they lack a private space to conduct sensitive exams, and 20% of providers mentioned that the needed antibiotic was unavailable. The alternative antibiotic was also missing. Most providers agree that they face difficulty prescribing antibiotics due to a lack of rapid diagnostic tests. 75% of providers mentioned being more conservative in antibiotic prescription, and 25% said they were the same. 75% think that antibiotics are appropriately prescribed in this population, and 25% believe that they are overprescribed. Eighty percent of providers agree that their understanding of this population's antibiogram or multidrug-resistant organisms was limited. 75% of providers mentioned no challenges when completing the Antibiotic stewardship form. 40% of providers were informed that they did not have to complete the Antibiotic stewardship form for UTI.

Conclusions: Our preliminary data show that some of the challenges providers face when providing medical care in mobile clinics are not having the antibiotics they initially wanted to prescribe, not having a private space for conducting sensitive physical exams, and a lack of rapid diagnostic tests. One possible solution is to secure funding for the point-of-care diagnostic test. Another important insight is the variability in prescribing practices among providers who may rely on their home institution's antibiograms rather than local antibiograms. A potential solution is to create a region-specific antibiogram tailored to the microbial landscape of Tijuana. Providing this resource to incoming providers significantly enhances patient-centered care. Lastly, providers must complete the Antibiotic Stewardship form when prescribing antibiotics at the Saturday Outreach Shelters. Our data shows that the providers are not having difficulties completing the form; instead, they receive contradicting information. A potential solution could be improving communication between the Saturday Outreach coordinators and providers, as well as among the coordinators, about which diagnoses require completing the Antimicrobial Stewardship form.

Reference

Chakladar J., Gonzalez C., Janeway H., Mizuno M., Longstaff X., et al. Antimicrobial Stewardship in Outreach Clinics in Tijuana. DGSOM Discovery Scholarship Day 2024. Retrieved April 21, 2025. https://apps.medsch.ucla.edu/posters/s/dsd/abstract/detail/1092