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

被引:26
作者
Crayton, Elise [1 ]
Richardson, Michelle [2 ]
Fuller, Chris [3 ]
Smith, Catherine [3 ]
Liu, Sunny [1 ]
Forbes, Gillian [1 ]
Anderson, Niall [1 ,4 ]
Shallcross, Laura [3 ]
Michie, Susan [1 ,4 ]
Hayward, Andrew [5 ]
Lorencatto, Fabiana [1 ,4 ]
机构
[1] UCL, Ctr Behav Change, Dept Clin Educ & Hlth Psychol, 1-19 Torrington Pl, London WC1E 7HB, England
[2] UCL, Inst Educ IOE, London WC1H 0NS, England
[3] UCL, Inst Hlth Informat, London NW1 2DA, England
[4] Natl Inst Hlth Res NIHR, Hlth Protect Res Unit Evaluat Intervent, London BS8 2BN, England
[5] UCL, Inst Epidemiol & Hlth, London WC1E 7HB, England
基金
英国经济与社会研究理事会;
关键词
Antimicrobial stewardship; Behavioural sciences; Nursing homes; Systematic review; BEHAVIOR-CHANGE TECHNIQUES; ANTIMICROBIAL STEWARDSHIP PROGRAMS; URINARY-TRACT-INFECTIONS; MULTIFACETED INTERVENTION; EDUCATIONAL INTERVENTION; CLOSTRIDIUM-DIFFICILE; PHYSICAL-ACTIVITY; NURSING-HOMES; RESIDENTS; IMPACT;
D O I
10.1186/s12877-020-01564-1
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
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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页数:24
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