Interventions to improve antimicrobial prescribing of doctors in training: the IMPACT (IMProving Antimicrobial presCribing of doctors in Training) realist review

Abstract

IntroductionAntimicrobial resistance has been described as a global crisis—more prudent prescribing is part of the solution. Behaviour change interventions are needed to improve prescribing practice. Presently, the literature documents that context impacts on prescribing decisions, yet insufficient evidence exists to enable researchers and policymakers to determine how local tailoring should take place. Doctors in training are an important group to study, being numerically the largest group of prescribers in UK hospitals. Unfortunately very few interventions specifically targeted this group.Methods and analysisOur project aims to understand how interventions to change antimicrobial prescribing behaviours of doctors in training produce their effects. We will recruit a project stakeholder group to advise us throughout. We will synthesise the literature using the realist review approach—a form of theory-driven interpretive systematic review approach often used to make sense of complex interventions. Interventions to improve antimicrobial prescribing behaviours are complex—they are context dependent, have long implementation chains, multiple non-linear interactions, emergence and depend on human agency. Our review will iteratively progress through 5 steps: step 1—Locate existing theories; step 2—Search for evidence; step 3—Article selection; step 4—Extracting and organising data; and step 5—Synthesising the evidence and drawing conclusions. Data analysis will use a realist logic of analysis to describe and explain what works, for whom, in what circumstances, in what respects, how and why to improve antimicrobial prescribing behaviour of doctors in training.Ethics and disseminationEthical approval was not required for our review. Our dissemination strategy will be participatory and involve input from our stakeholder group. Tailored project outputs will be targeted at 3 audiences: (1) doctors in training; (2) clinical supervisors/trainers and medical educators; and (3) policy, decision makers, regulators and royal societies.

Predictors of Antimicrobial Stewardship Program Recommendation Disagreement

“…This finding underscores the need for incorporating antimicrobial stewardship into continuing education strategies for all physicians. 13,14 Our study results indicated that PAFR for audits performed on patients in the PICU were less likely to be followed compared to PAFR for audits performed on patients in the NICU. This finding directly contrasts with that of another single-center study that identified NICU and hematologyoncology services as more likely to disagree with PAFR compared to hospitalist service but found no difference with the PICU.…”

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

“…We followed a similar methodology to that used in a previous National Institute for Health Research Health Services and Delivery Research programme project 54 that was conducted by many of the same research team members. 54,55 Any evidence synthesis that seeks to make sense of interventions aiming to improve doctors' mental ill-health must take into account the contexts in which these interventions are situated. This generates an in-depth understanding of which components within these interventions matter more (or less) than others, for whom they matter and in what ways.…”

“…Note that dashed arrows indicate iteration where necessary. Reproduced from Wong et al 54 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.…”

Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

“…The review ran for an 18-month period from June 2015 until November 2016. The protocol has been published in BMJ Open 46 and the review has been registered with PROSPERO (CRD42015017802). 47 We were granted ethics clearance by the Central University Research Ethics Committee at the University of Oxford.…”