Improving healthcare professionals’ interactions with patients to tackle antimicrobial resistance

BACKGROUND: Antimicrobial resistance (AMR) is one of the most important public health threats. It is important for healthcare professionals (HCPs) who prescribe, dispense, administer and/or monitor antimicrobials to mitigate inappropriate antimicrobial use. This review identified existing interventions which aim to improve HCPs’ interaction with patients and examined factors that enables or hinders appropriate behaviours. METHODS: We searched MEDLINE, EMBASE, Science Citation Index, Social Sciences Citation Index, Google Scholar, internet and conducted forward and backward citation searching from eligible studies. We included studies of any design, published in English language from year 2010 to 2023. We applied narrative synthesis and used the COM-B (Capability, Opportunity, Motivation - Behaviour) as a theoretical framework for barriers and facilitators at HCP and patient levels. RESULTS: We included 59 studies of diverse designs examining a range of interventions from 16 countries. Many interventions involved multiple components beyond HCPs’ interaction with patients, e.g., Treat Antibiotics Responsibly, Guidance, Education and Tools (TARGET). Patient interaction components mostly involved use of posters, leaflets, videos, interactive decision support tools and C reactive protein point-of-care testing. The interventions were often found to be useful. Barriers and facilitators identified related to capability (e.g., knowledge/understanding about AMR, diagnostic uncertainties, awareness of interventions, forgetfulness); opportunity (e.g., time constraint, intervention accessibility) and motivation (e.g., patient's desire for antibiotics, fear of litigation). CONCLUSIONS: There are many useful interventions to improve HCPs and patients’ interactions for appropriate behaviours in antibiotic use. The barriers and facilitators identified in this review should be considered by intervention designers/adopters and policy makers to improve implementation and effectiveness. KEY MESSAGES: • Factors hindering appropriate antimicrobial use are complex. • This review can inform the development and implementation of strategies to improve healthcare professional’ interaction with the users.