Prioritizing research areas for antibiotic stewardship programmes in hospitals: a behavioural perspective consensus paper

Rzewuska, Magdalena; Charani, Esmita; Clarkson, Jan E; Davey, Peter; Duncan, Eilidh; Francis, Jill J; Gillies, Katie; Kern, Winfried V.; Lorencatto, Fabiana; Marwick, Charis; McEwen, J.; Mohler, R. Albert; Morris, Andrew M.; Ramsay, Craig R; Katwyk, Susan Rogers Van; Skodvin, Brita; Smith, Ingrid; Suh, Kathryn N.; Grimshaw, Jeremy

doi:10.1016/j.cmi.2018.08.020

Cited by 58 publications

(40 citation statements)

References 28 publications

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“…There is scope to explore a broader range of interventions to improve antimicrobial stewardship practice, particularly interventions that target social and motivational drivers of behaviour. There is a need for more intervention development and evaluation in antimicrobial stewardship that draws on behavioural and social science [40].…”

Section: Strengths Limitations and Implicationsmentioning

confidence: 99%

Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review

et al. 2020

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Background: Overuse of antibiotics has contributed to antimicrobial resistance; a growing public health threat. In long-term care facilities, levels of inappropriate prescribing are as high as 75%. Numerous interventions targeting long-term care facilities' antimicrobial stewardship have been reported with varying, and largely unexplained, effects. Therefore, this review aimed to apply behavioural science frameworks to specify the component behaviour change techniques of stewardship interventions in long-term care facilities and identify those components associated with improved outcomes. Method: A systematic review (CRD42018103803) was conducted through electronic database searches. Two behavioural science frameworks, the Behaviour Change Wheel and Behaviour Change Technique Taxonomy were used to classify intervention descriptions into intervention types and component behaviour change techniques used. Study design and outcome heterogeneity prevented meta-analysis and meta-regression. Interventions were categorised as 'very promising' (all outcomes statistically significant), 'quite promising' (some outcomes statistically significant), or 'not promising' (no outcomes statistically significant). 'Promise ratios' (PR) were calculated for identified intervention types and behaviour change techniques by dividing the number of (very or quite) promising interventions featuring the intervention type or behaviour change technique by the number of interventions featuring the intervention type or behaviour change technique that were not promising. Promising intervention types and behaviour change techniques were defined as those with a PR ≥ 2. Results: Twenty studies (of19 interventions) were included. Seven interventions (37%) were 'very promising', eight 'quite promising' (42%) and four 'not promising' (21%). Most promising intervention types were 'persuasion' (n = 12; promise ratio (PR) = 5.0), 'enablement' (n = 16; PR = 4.33) and 'education' (n = 19; PR = 3.75). Most promising behaviour change techniques were 'feedback on behaviour' (n = 9; PR = 8.0) and 'restructuring the social environment' (e.g. staff role changes; n = 8; PR = 7.0).

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Section: Strengths Limitations and Implicationsmentioning

confidence: 99%

Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review

et al. 2020

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“…This may include inputs across social sciences, behavioral, economic, and medical research. 88 For the long-term sustainability of research activities, it is important to put in place a dedicated budget at the national level.…”

Section: -Amr Researchmentioning

confidence: 99%

A governance framework for development and assessment of national action plans on antimicrobial resistance

Anderson

Schulze

Cassini

et al. 2019

The Lancet Infectious Diseases

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Strengthening governance is an essential strategy to tackling antimicrobial resistance (AMR) at all levels; global, national, regional and local. To date, no systematic approach to governance of AMR national action plans (NAPs) exists. To address this, we aimed to develop the first governance framework to offer guidance for both the development and assessment of AMR national action plans (NAPs). We reviewed health system governance framework reviews to inform the basic structure of our framework, international guidance documents from the WHO, FAO, OIE and the EU, and sought the input of over 25 experts from international organizations, government ministries, policy institutes and academic institutions to develop and refine our framework. The framework consists of 18 domains with 52 indicators that are contained within three governance areas: "policy design", "implementation tools", and "monitoring and evaluation". To consider the dynamic nature of AMR, the framework is conceptualized as a cyclical process, which is responsive to the context and allows for continuous improvement and adaptation of AMR NAPs. Key messages • Antimicrobial Resistance (AMR) is one of the most pressing and complex issues today, with multi drug-resistant, extensively drug-resistant, and even pan drug-resistant organisms emerging. • AMR is driven by interrelated dynamics in the human, animal, and environmental health sectors, which makes governance challenging. • Strengthening governance of AMR policies at all levels; global, national, regional and local, is essential to tackling AMR. To date, no comprehensive framework for the governance of AMR National Action Plans (NAPs) has been developed. • To our knowledge, this is the first study that has developed a governance framework for AMR NAPs, based on a systematic review of the literature, international guidance, and over 20 experts from various international organizations, government ministries, policy institutes and academic institutions • The framework is conceptualized as a cyclical process between the three governance areas; policy design, implementation tools, and monitoring and evaluation.

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“…Selain itu, bukti penelitian juga dapat bermanfaat pada situasi dimana terdapat kebutuhan untuk memilih suatu program dari beberapa alternatif program yang tersedia, seperti halnya strategi ASP. Kebutuhan untuk menghasilkan (generate) dan menggunakan bukti penelitian dalam perencanaan dan pengembangan ASP direkomendasikan sebagai salah satu agenda utama penelitian untuk menjaga keberlangsungan implementasi ASP jangka panjang [54].…”

Section: Tema 3: Pemanfaatan Bukti Penelitian Sebagai Dasar Penyusunaunclassified

Persepsi Dokter tentang Strategi Antimicrobial Stewardship Program di Sebuah Rumah Sakit Umum di Surabaya

2020

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Antimicrobial Stewardship Program (ASP) dikembangkan untuk mengoptimalkan penggunaan antibiotik melalui implementasi kebijakan, strategi maupun pedoman. Penelitian ini bertujuan untuk mengkaji persepsi dokter terhadap ASP dan mengeksplorasi pilihan beserta pertimbangan pemilihan suatu jenis strategi ASP. Pendekatan kualitatif melalui wawancara dengan dokter yang aktif bekerja di sebuah rumah sakit umum di kota Surabaya dilakukan dengan bantuan panduan wawancara semi terstruktrur untuk mengeksplorasi: i) sikap terhadap implementasi ASP, dan ii) strategi ASP yang disarankan. Hasil wawancara diolah secara thematic analysis. Sebanyak 27 dokter bersedia terlibat. Secara umum, partisipan memiliki sikap yang baik terhadap implementasi ASP. Terdapat tiga tema terkait implementasi ASP, yaitu: 1) persetujuan implementasi sebagai konsekuensi dari bagian komunitas profesi di rumah sakit (RS); 2) relevansi implementasi bagi perbaikan kualitas RS, dan 3) tuntutan pemenuhan sumber daya sebelum diimplementasikan. Pembuatan pedoman terapi atau clinical pathway merupakan strategi yang paling banyak dipilih oleh partisipan. Pertimbangan dalam memilih suatu strategi adalah: 1) kesepakatan oleh komunitas RS; 2) practicability dan feasibility; dan 3) penggunaan bukti penelitian sebagai dasar penyusunan strategi. Penelitian ini memberikan gambaran mengenai persepsi dokter terkait dengan implementasi ASP. Diharapkan hasil penelitian ini dapat dijadikan sebagai salah satu acuan dalam merancang strategi ASP yang tepat dalam konteks RS di Indonesia.

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Prioritizing research areas for antibiotic stewardship programmes in hospitals: a behavioural perspective consensus paper

Abstract: Assessment, revisions and updates of our priority-setting exercise should be considered at intervals of 2 years. To propose research priority areas in low- and middle-income countries, the methodology reported here could be applied.

Cited by 58 publications

References 28 publications

Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review

Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review

A governance framework for development and assessment of national action plans on antimicrobial resistance

Persepsi Dokter tentang Strategi Antimicrobial Stewardship Program di Sebuah Rumah Sakit Umum di Surabaya

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