Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

Abstract

A major modifiable factor contributing to antimicrobial resistance (AMR) is inappropriate use and overuse of antimicrobials, such as antibiotics. This study aimed to describe the content and mechanism of action of antimicrobial stewardship (AMS) interventions to improve appropriate antibiotic use for respiratory tract infections (RTI) in primary and community care. This study also aimed to describe who these interventions were aimed at and the specific behaviors targeted for change. Evidence-based guidelines, peer-review publications, and infection experts were consulted to identify behaviors relevant to AMS for RTI in primary care and interventions to target these behaviors. Behavior change tools were used to describe the content of interventions. Theoretical frameworks were used to describe mechanisms of action. A total of 32 behaviors targeting six different groups were identified (patients; prescribers; community pharmacists; providers; commissioners; providers and commissioners). Thirty-nine interventions targeting the behaviors were identified (patients = 15, prescribers = 22, community pharmacy staff = 8, providers = 18, and commissioners = 18). Interventions targeted a mean of 5.8 behaviors (range 1–27). Influences on behavior most frequently targeted by interventions were psychological capability (knowledge and skills); reflective motivation (beliefs about consequences, intentions, social/professional role and identity); and physical opportunity (environmental context and resources). Interventions were most commonly characterized as achieving change by training, enabling, or educating and were delivered mainly through guidelines, service provision, and communications & marketing. Interventions included a mean of four Behavior Change Techniques (BCTs) (range 1–14). We identified little intervention content targeting automatic motivation and social opportunity influences on behavior. The majority of interventions focussed on education and training, which target knowledge and skills though the provision of instructions on how to perform a behavior and information about health consequences. Interventions could be refined with the inclusion of relevant BCTs, such as goal-setting and action planning (identified in only a few interventions), to translate instruction on how to perform a behavior into action. This study provides a platform to refine content and plan evaluation of antimicrobial stewardship interventions.

Are We Making the Most of Community Pharmacies? Implementation of Antimicrobial Stewardship Measures in Community Pharmacies: A Narrative Review

“…A recent study investigating behaviors related to antimicrobial stewardship for respiratory tract infections in primary care found that 5 of 32 were community pharmacy behaviors, mostly patient education [ 34 ]. A study by Revolinski et al showed varied antimicrobial stewardship practices in community pharmacies, with patient education and allergy assessment being among the most prevalent [ 35 ].…”

Optimising antimicrobial stewardship interventions in English primary care: a behavioural analysis of qualitative and intervention studies

“…Second, we conducted a rapid review of intervention studies to identify research evidence on effective AMS interventions. We then compared these research interventions with previously identified national AMS interventions 6 to see which effective interventions have been already nationally implemented. Third, we conducted a behavioural analysis, using behaviour sciences frameworks and matrices, to compare the extent to which national and research AMS interventions (stage 2) address the key influences on antibiotic prescribing (stage 1).…”

“… 5 Recently, 39 nationally implemented interventions (with 22 targeted at prescribers) were identified that aimed at reducing antibiotic prescribing and use for RTIs in England alone. 6 Considering the large number of interventions and the typically modest effects, it would be informative to identify how well the interventions address influences on antibiotic prescribing and whether interventions have ‘gaps’ which could highlight areas for improvement.…”

“…Such behavioural analysis methods have been used, for example, to assess interventions to prevent sepsis, 11 catheter-associated urinary tract infections, 12 AMS interventions targeted at public 13 and national AMS interventions. 6 …”

“…Building on a recent study that assessed the behavioural content of national AMS interventions in England, 6 the overall aim of this study was to identify possible ways to optimise AMS interventions in English primary care. To achieve this we aimed to assess the extent to which current national and research interventions addressed influences on antibiotic prescribing (and identify any potential gaps) by addressing the following objectives:…”