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Evidence-Based Strategies in Using Persuasive Interventions to Optimize Antimicrobial Use in Healthcare: a Narrative Review

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Abstract

A rise in antimicrobial resistance, seen especially since 2000, is in part caused by indiscriminate antimicrobial use. Varied types of persuasive interventions aimed to optimize antimicrobial use have been tried with varying success. Our review seeks to identify and assess factors associated with the successful implementation of persuasive interventions. We searched five databases (MEDLINE, EMBASE, The Cochrane Library, PsycINFO, and ERIC) to identify critical studies published between 2000 and December 2018 of interventions employing audit and feedback, education through meetings, academic detailing, reminders, and patient, family, or public education. Outcome measures of interest were any means to measure antimicrobial use. We included 26 articles in our analysis. Seventeen examined multimodal interventions and the most common was audit and feedback and meeting (four studies). Nine examined single interventions and the most common was audit and feedback (five studies). Our findings inform four evidence-based strategies to enable healthcare administrators, clinicians, and researchers to make informed choices when planning and designing an antimicrobial stewardship program: (1) implement a combination of persuasive interventions from both groups: audit and feedback, academic detailing, or patient, family, or provider education; and meeting or reminders, (2) design interventions that last one year or longer; post-intervention, assess the intervention’s long-term effects for at least another one year, (3) conduct quality improvement projects examining persuasive interventions if the prescribing database provides adequate diagnosis information, and most importantly, (4) make patient, family, or provider education an integral component of multimodal intervention.

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Fig. 1

Abbreviations

AD:

Academic detailing

AF:

Audit and feedback

CBA:

Controlled before-after

ITS:

Interrupted time-series

PFPE:

Patient, family, or public education

M:

Meeting

MMI:

Multimodal Interventions

R:

Reminder

RCT:

Randomized controlled trial

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Acknowledgements

The authors would like to acknowledge the help of Professor Matthew Lunde Ph.D. for reading and providing feedback on the manuscript.

Author information

Correspondence to Jun Rong Jeffrey Neo.

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This article is part of the Topical Collection on Education & Training

Appendices

Appendix 1 List of search terms

Ovid MEDLINE® Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE® Daily and Ovid MEDLINE® - 1946 to Present

Date Searched: December 31, 2018

#Search
1exp Drug Resistance, Microbial/
2(“antimicrobial drug resistan*” or “antibiotic resistan*”).tw.
3(“bacterial drug resistan*” or “antibacterial drug resistan*”).tw.
4“beta Lactam resistan*”.tw.
5“cephalosporin resistan*”.tw.
6“penicillin resistan*”.tw.
7“ampicillin resistan*”.tw.
8“methicillin resistan*”.tw.
9“chloramphenicol resistan*”.tw.
10“kanamycin resistan*”.tw.
11“tetracycline resistan*”.tw.
12“trimethoprim resistan*”.tw.
13“vancomycin resistan*”.tw.
14(“fungal drug resistan*” or “antifungal drug resistan*”).tw.
15“multidrug resistan*”.tw.
16“antiviral drug resistan*”.tw.
17or/1–16
18Education/
19(educat* or workshop or workshops or train* or “literacy program” or “literacy programs” or stewardship or teach*).tw.
20Education, Predental/
21Education, Premedical/
22Education, Professional/
23Clinical Clerkship/
24(“clinical clerkship” or “clinical clerkships” or “clinical apprenticeship” or “clinical apprenticeships”).tw.
25exp Education, Continuing/
26exp Education, Graduate/
27Education, Medical/
28Education, Nursing/
29Education, Pharmacy/
30Education, Public Health Professional/
31Mentoring/
32(mentor or mentoring or mentorship or mentors or coaching).tw.
33Preceptorship/
34(preceptorship or “medical field study” or “medical field studies” or “clinical practicum” or “clinical practicums” or “medical field work”).tw.
35Teacher Training/
36Inservice Training/
37(“orientation program” or “orientation programs” or “employee orientation”).tw.
38Staff Development/
39(“staff development” or “employee cross training”).tw.
40Teaching/
41or/18–40
42Communication/
43(communicate or communicating or communication or communications).tw.
44Information Dissemination/
45(“information dissemination” or “information distribution” or “information sharing” or “information sharings” or “data sharing” or “data sharings”).tw.
46Health Literacy/
47“health literacy”.tw.
48or/42–47
4941 or 48
5017 and 49
51limit 50 to yr = “2006 -Current”
52animals/ not humans/
5351 not 52

Appendix 2

Table 1 Characteristics of included studies

Appendix 3

Table 2 Summary of results

Appendix 4

Table 3 Study findings

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Neo, J.R.J., Niederdeppe, J., Vielemeyer, O. et al. Evidence-Based Strategies in Using Persuasive Interventions to Optimize Antimicrobial Use in Healthcare: a Narrative Review. J Med Syst 44, 64 (2020). https://doi.org/10.1007/s10916-020-1531-y

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Keywords

  • Antimicrobial resistance
  • Antimicrobial management
  • Antibiotic prescription
  • Antibiotic usage
  • Persuasive interventions
  • Antibiotic resistance