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

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 report...

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Autores principales: Crayton, Elise, Richardson, Michelle, Fuller, Chris, Smith, Catherine, Liu, Sunny, Forbes, Gillian, Anderson, Niall, Shallcross, Laura, Michie, Susan, Hayward, Andrew, Lorencatto, Fabiana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350746/
https://www.ncbi.nlm.nih.gov/pubmed/32646382
http://dx.doi.org/10.1186/s12877-020-01564-1
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author Crayton, Elise
Richardson, Michelle
Fuller, Chris
Smith, Catherine
Liu, Sunny
Forbes, Gillian
Anderson, Niall
Shallcross, Laura
Michie, Susan
Hayward, Andrew
Lorencatto, Fabiana
author_facet Crayton, Elise
Richardson, Michelle
Fuller, Chris
Smith, Catherine
Liu, Sunny
Forbes, Gillian
Anderson, Niall
Shallcross, Laura
Michie, Susan
Hayward, Andrew
Lorencatto, Fabiana
author_sort Crayton, Elise
collection PubMed
description 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). CONCLUSION: Systematic identification of the active ingredients of antimicrobial stewardship in long-term care facilities was facilitated through the application of behavioural science frameworks. Incorporating environmental restructuring and performance feedback may be promising intervention strategies for antimicrobial stewardship interventions within long-term care facilities.
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spelling pubmed-73507462020-07-14 Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review Crayton, Elise Richardson, Michelle Fuller, Chris Smith, Catherine Liu, Sunny Forbes, Gillian Anderson, Niall Shallcross, Laura Michie, Susan Hayward, Andrew Lorencatto, Fabiana BMC Geriatr Research Article 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). CONCLUSION: Systematic identification of the active ingredients of antimicrobial stewardship in long-term care facilities was facilitated through the application of behavioural science frameworks. Incorporating environmental restructuring and performance feedback may be promising intervention strategies for antimicrobial stewardship interventions within long-term care facilities. BioMed Central 2020-07-09 /pmc/articles/PMC7350746/ /pubmed/32646382 http://dx.doi.org/10.1186/s12877-020-01564-1 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data.
spellingShingle Research Article
Crayton, Elise
Richardson, Michelle
Fuller, Chris
Smith, Catherine
Liu, Sunny
Forbes, Gillian
Anderson, Niall
Shallcross, Laura
Michie, Susan
Hayward, Andrew
Lorencatto, Fabiana
Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review
title Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review
title_full Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review
title_fullStr Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review
title_full_unstemmed Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review
title_short Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review
title_sort interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350746/
https://www.ncbi.nlm.nih.gov/pubmed/32646382
http://dx.doi.org/10.1186/s12877-020-01564-1
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