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Development of an intervention to reduce antibiotic use for childhood coughs in UK primary care using critical synthesis of multi-method research

BACKGROUND: Overuse of antibiotics contributes to the global threat of antimicrobial resistance. Antibiotic stewardship interventions address this threat by reducing the use of antibiotics in occasions or doses unlikely to be effective. We aimed to develop an evidence-based, theory-informed, interve...

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Autores principales: Lucas, Patricia J., Ingram, Jenny, Redmond, Niamh M., Cabral, Christie, Turnbull, Sophie L., Hay, Alastair D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745782/
https://www.ncbi.nlm.nih.gov/pubmed/29281974
http://dx.doi.org/10.1186/s12874-017-0455-9
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author Lucas, Patricia J.
Ingram, Jenny
Redmond, Niamh M.
Cabral, Christie
Turnbull, Sophie L.
Hay, Alastair D.
author_facet Lucas, Patricia J.
Ingram, Jenny
Redmond, Niamh M.
Cabral, Christie
Turnbull, Sophie L.
Hay, Alastair D.
author_sort Lucas, Patricia J.
collection PubMed
description BACKGROUND: Overuse of antibiotics contributes to the global threat of antimicrobial resistance. Antibiotic stewardship interventions address this threat by reducing the use of antibiotics in occasions or doses unlikely to be effective. We aimed to develop an evidence-based, theory-informed, intervention to reduce antibiotic prescriptions in primary care for childhood respiratory tract infections (RTI). This paper describes our methods for doing so. METHODS: Green and Krueter’s Precede/Proceed logic model was used as a framework to integrate findings from a programme of research including 5 systematic reviews, 3 qualitative studies, and 1 cohort study. The model was populated using a strength of evidence approach, and developed with input from stakeholders including clinicians and parents. RESULTS: The synthesis produced a series of evidence-based statements summarizing the quantitative and qualitative evidence for intervention elements most likely to result in changes in clinician behaviour. Current evidence suggests that interventions which reduce clinical uncertainty, reduce clinician/parent miscommunication, elicit parent concerns, make clear delayed or no-antibiotic recommendations, and provide clinicians with alternate treatment actions have the best chance of success. We designed a web-based within-consultation intervention to reduce clinician uncertainty and pressure to prescribe, designed to be used when children with RTI present to a prescribing clinician in primary care. CONCLUSIONS: We provide a worked example of methods for the development of future complex interventions in primary care, where multiple factors act on multiple actors within a complex system. Our synthesis provided intervention guidance, recommendations for practice, and highlighted evidence gaps, but questions remain about how best to implement these recommendations. The funding structure which enabled a single team of researchers to work on a multi-method programme of related studies (NIHR Programme Grant scheme) was key in our success. TRIAL REGISTRATION: The feasibility study accompanying this intervention was prospectively registered with the ISRCTN registry (ISRCTN23547970), on 27 June 2014. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12874-017-0455-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-57457822018-01-03 Development of an intervention to reduce antibiotic use for childhood coughs in UK primary care using critical synthesis of multi-method research Lucas, Patricia J. Ingram, Jenny Redmond, Niamh M. Cabral, Christie Turnbull, Sophie L. Hay, Alastair D. BMC Med Res Methodol Research Article BACKGROUND: Overuse of antibiotics contributes to the global threat of antimicrobial resistance. Antibiotic stewardship interventions address this threat by reducing the use of antibiotics in occasions or doses unlikely to be effective. We aimed to develop an evidence-based, theory-informed, intervention to reduce antibiotic prescriptions in primary care for childhood respiratory tract infections (RTI). This paper describes our methods for doing so. METHODS: Green and Krueter’s Precede/Proceed logic model was used as a framework to integrate findings from a programme of research including 5 systematic reviews, 3 qualitative studies, and 1 cohort study. The model was populated using a strength of evidence approach, and developed with input from stakeholders including clinicians and parents. RESULTS: The synthesis produced a series of evidence-based statements summarizing the quantitative and qualitative evidence for intervention elements most likely to result in changes in clinician behaviour. Current evidence suggests that interventions which reduce clinical uncertainty, reduce clinician/parent miscommunication, elicit parent concerns, make clear delayed or no-antibiotic recommendations, and provide clinicians with alternate treatment actions have the best chance of success. We designed a web-based within-consultation intervention to reduce clinician uncertainty and pressure to prescribe, designed to be used when children with RTI present to a prescribing clinician in primary care. CONCLUSIONS: We provide a worked example of methods for the development of future complex interventions in primary care, where multiple factors act on multiple actors within a complex system. Our synthesis provided intervention guidance, recommendations for practice, and highlighted evidence gaps, but questions remain about how best to implement these recommendations. The funding structure which enabled a single team of researchers to work on a multi-method programme of related studies (NIHR Programme Grant scheme) was key in our success. TRIAL REGISTRATION: The feasibility study accompanying this intervention was prospectively registered with the ISRCTN registry (ISRCTN23547970), on 27 June 2014. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12874-017-0455-9) contains supplementary material, which is available to authorized users. BioMed Central 2017-12-28 /pmc/articles/PMC5745782/ /pubmed/29281974 http://dx.doi.org/10.1186/s12874-017-0455-9 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Lucas, Patricia J.
Ingram, Jenny
Redmond, Niamh M.
Cabral, Christie
Turnbull, Sophie L.
Hay, Alastair D.
Development of an intervention to reduce antibiotic use for childhood coughs in UK primary care using critical synthesis of multi-method research
title Development of an intervention to reduce antibiotic use for childhood coughs in UK primary care using critical synthesis of multi-method research
title_full Development of an intervention to reduce antibiotic use for childhood coughs in UK primary care using critical synthesis of multi-method research
title_fullStr Development of an intervention to reduce antibiotic use for childhood coughs in UK primary care using critical synthesis of multi-method research
title_full_unstemmed Development of an intervention to reduce antibiotic use for childhood coughs in UK primary care using critical synthesis of multi-method research
title_short Development of an intervention to reduce antibiotic use for childhood coughs in UK primary care using critical synthesis of multi-method research
title_sort development of an intervention to reduce antibiotic use for childhood coughs in uk primary care using critical synthesis of multi-method research
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745782/
https://www.ncbi.nlm.nih.gov/pubmed/29281974
http://dx.doi.org/10.1186/s12874-017-0455-9
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