Behavior Change Strategies to Influence Antimicrobial Prescribing in Acute Care: A Systematic Review

Abstract

Despite qualitative evidence demonstrating the impact of behavioral determinants and social norms on prescribing, these influences are not given due consideration in the design and evaluation of interventions. To ensure a better understanding of prescribing behaviors and to improve the quality of interventions and research in this area, the incorporation and application of behavioral sciences supported by appropriate multidisciplinary collaboration is recommended.

Effects of a bundled Antimicrobial Stewardship Program on mortality: a cohort study

“…We believe that antimicrobial stewardship will continue to evolve in the upcoming decade, and among various interventions, prospective audit and feedback will probably be the most implemented strategy, in view of its clear advantages: particularly, lack of prescribers' opposition and prescribing behavior modification. 25 Future researches should focus on evaluating the role and ways to improve clinical effectiveness of different bundled strategies, especially those interventions that may increase the rate of bacteria isolation, which translates into correctly selecting ADT to treat specific microorganisms. There is also an urgent need to standardize outcomes as well as develop novel study designs that can objectively assess antimicrobial stewardship interventions, despite the limitations and opportunities inherent to ASPs heterogeneous structures and process.…”

Healthcare‐acquired infections: prevention strategies

“…'Prescribing etiquette,' that is, the reluctance to contradict prescriptions of colleagues and an inclination to follow the precedent of senior staff, is an embedded determinant of prescribing. [71][72][73] Consequentially, an unquestioning approach takes precedence over adherence to existing antibiotics policies, guidelines and advice. Few junior doctors feel empowered to question prescribing they feel to be inappropriate.…”

“…74 Current AMS programmes that target junior medical staff often fail to recognise the difficulties in challenging this ingrained cultural hierarchy. 71,72,74 As medical personnel value autonomy, 75 the success of AMS initiatives is maximised when developed within a framework of collaboration and collegiality. 76 Ultimately, for AMS to be effective, initiatives need the sustained endorsement of senior clinicians and engagement by the hospital leadership.…”

‘Esprit de corps’: Towards collaborative integration of pharmacists and nurses into antimicrobial stewardship programmes in South Africa

“…[2,3] In this regard, effective ASPs depend largely on monitoring practices, teamwork in developing and implementing interventions, and organisational infrastructure. [2] It is therefore critical in the SA context to utilise the existing resources of pharmacists and registered nurses (RNs), who are well placed to co-ordinate anti-infective management and improve patient outcomes. To date, initiatives in SA to promote optimal antimicrobial prescribing have primarily targeted the practices of hospital-based doctors.…”