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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Audit and feedback
Patient, family, or public education
Randomized controlled trial
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The authors would like to acknowledge the help of Professor Matthew Lunde Ph.D. for reading and providing feedback on the manuscript.
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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
|1||exp 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.|
|14||(“fungal drug resistan*” or “antifungal drug resistan*”).tw.|
|16||“antiviral drug resistan*”.tw.|
|19||(educat* or workshop or workshops or train* or “literacy program” or “literacy programs” or stewardship or teach*).tw.|
|24||(“clinical clerkship” or “clinical clerkships” or “clinical apprenticeship” or “clinical apprenticeships”).tw.|
|25||exp Education, Continuing/|
|26||exp Education, Graduate/|
|30||Education, Public Health Professional/|
|32||(mentor or mentoring or mentorship or mentors or coaching).tw.|
|34||(preceptorship or “medical field study” or “medical field studies” or “clinical practicum” or “clinical practicums” or “medical field work”).tw.|
|37||(“orientation program” or “orientation programs” or “employee orientation”).tw.|
|39||(“staff development” or “employee cross training”).tw.|
|43||(communicate or communicating or communication or communications).tw.|
|45||(“information dissemination” or “information distribution” or “information sharing” or “information sharings” or “data sharing” or “data sharings”).tw.|
|49||41 or 48|
|50||17 and 49|
|51||limit 50 to yr = “2006 -Current”|
|52||animals/ not humans/|
|53||51 not 52|
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Cite this article
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
- Antimicrobial resistance
- Antimicrobial management
- Antibiotic prescription
- Antibiotic usage
- Persuasive interventions
- Antibiotic resistance