Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice
Abstract Background Trials show that antimicrobial stewardship (AMS) strategies, including communication skills training, point-of-care C-reactive protein testing (POC-CRPT) and delayed prescriptions, help optimise antibiotic prescribing and use in primary care. However, the use of these strategies...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-09-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-021-00209-7 |
| _version_ | 1818664335578234880 |
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| author | Aleksandra J. Borek Anne Campbell Elle Dent Michael Moore Christopher C. Butler Alison Holmes A. Sarah Walker Monsey McLeod Sarah Tonkin-Crine on behalf of the STEP-UP study team |
| author_facet | Aleksandra J. Borek Anne Campbell Elle Dent Michael Moore Christopher C. Butler Alison Holmes A. Sarah Walker Monsey McLeod Sarah Tonkin-Crine on behalf of the STEP-UP study team |
| author_sort | Aleksandra J. Borek |
| collection | DOAJ |
| description | Abstract Background Trials show that antimicrobial stewardship (AMS) strategies, including communication skills training, point-of-care C-reactive protein testing (POC-CRPT) and delayed prescriptions, help optimise antibiotic prescribing and use in primary care. However, the use of these strategies in general practice is limited and inconsistent. We aimed to develop an intervention to enhance uptake and implementation of these strategies in primary care. Methods We drew on the Person-Based Approach to develop an implementation intervention in two stages. (1) Planning and design: We defined the problem in behavioural terms drawing on existing literature and conducting primary qualitative research (nine focus groups) in high-prescribing general practices. We identified ‘guiding principles’ with intervention objectives and key features and developed logic models representing intended mechanisms of action. (2) Developing the intervention: We created prototype intervention materials and discussed and refined these with input from 13 health professionals and 14 citizens in two sets of design workshops. We further refined the intervention materials following think-aloud interviews with 22 health professionals. Results Focus groups highlighted uncertainties about how strategies could be used. Health professionals in the workshops suggested having practice champions, brief summaries of each AMS strategy and evidence supporting the AMS strategies, and they and citizens gave examples of helpful communication strategies/phrases. Think-aloud interviews helped clarify and shorten the text and user journey of the intervention materials. The intervention comprised components to support practice-level implementation: antibiotic champions, practice meetings with slides provided, and an ‘implementation support’ website section, and components to support individual-level uptake: website sections on each AMS strategy (with evidence, instructions, links to electronic resources) and material resources (patient leaflets, POC-CRPT equipment, clinician handouts). Conclusions We used a systematic, user-focussed process of developing a behavioural intervention, illustrating how it can be used in an implementation context. This resulted in a multicomponent intervention to facilitate practice-wide implementation of evidence-based strategies which now requires implementing and evaluating. Focusing on supporting the uptake and implementation of evidence-based strategies to optimise antibiotic use in general practice is critical to further support appropriate antibiotic use and mitigate antimicrobial resistance. |
| first_indexed | 2024-12-17T05:31:06Z |
| format | Article |
| id | doaj.art-3a7db2702e9349b59a3dc8f62f849ac7 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-17T05:31:06Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-3a7db2702e9349b59a3dc8f62f849ac72022-12-21T22:01:44ZengBMCImplementation Science Communications2662-22112021-09-012111610.1186/s43058-021-00209-7Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practiceAleksandra J. Borek0Anne Campbell1Elle Dent2Michael Moore3Christopher C. Butler4Alison Holmes5A. Sarah Walker6Monsey McLeod7Sarah Tonkin-Crine8on behalf of the STEP-UP study teamNuffield Department of Primary Care Health Sciences, University of OxfordNational Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College LondonNuffield Department of Primary Care Health Sciences, University of OxfordPrimary Care Population Sciences and Medical Education, Faculty of Medicine, University of SouthamptonNuffield Department of Primary Care Health Sciences, University of OxfordNational Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College LondonNIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of OxfordNational Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College LondonNuffield Department of Primary Care Health Sciences, University of OxfordAbstract Background Trials show that antimicrobial stewardship (AMS) strategies, including communication skills training, point-of-care C-reactive protein testing (POC-CRPT) and delayed prescriptions, help optimise antibiotic prescribing and use in primary care. However, the use of these strategies in general practice is limited and inconsistent. We aimed to develop an intervention to enhance uptake and implementation of these strategies in primary care. Methods We drew on the Person-Based Approach to develop an implementation intervention in two stages. (1) Planning and design: We defined the problem in behavioural terms drawing on existing literature and conducting primary qualitative research (nine focus groups) in high-prescribing general practices. We identified ‘guiding principles’ with intervention objectives and key features and developed logic models representing intended mechanisms of action. (2) Developing the intervention: We created prototype intervention materials and discussed and refined these with input from 13 health professionals and 14 citizens in two sets of design workshops. We further refined the intervention materials following think-aloud interviews with 22 health professionals. Results Focus groups highlighted uncertainties about how strategies could be used. Health professionals in the workshops suggested having practice champions, brief summaries of each AMS strategy and evidence supporting the AMS strategies, and they and citizens gave examples of helpful communication strategies/phrases. Think-aloud interviews helped clarify and shorten the text and user journey of the intervention materials. The intervention comprised components to support practice-level implementation: antibiotic champions, practice meetings with slides provided, and an ‘implementation support’ website section, and components to support individual-level uptake: website sections on each AMS strategy (with evidence, instructions, links to electronic resources) and material resources (patient leaflets, POC-CRPT equipment, clinician handouts). Conclusions We used a systematic, user-focussed process of developing a behavioural intervention, illustrating how it can be used in an implementation context. This resulted in a multicomponent intervention to facilitate practice-wide implementation of evidence-based strategies which now requires implementing and evaluating. Focusing on supporting the uptake and implementation of evidence-based strategies to optimise antibiotic use in general practice is critical to further support appropriate antibiotic use and mitigate antimicrobial resistance.https://doi.org/10.1186/s43058-021-00209-7ImplementationBehaviour changeQualitativeAntibiotic prescribingAntimicrobial stewardshipAntibiotic resistance |
| spellingShingle | Aleksandra J. Borek Anne Campbell Elle Dent Michael Moore Christopher C. Butler Alison Holmes A. Sarah Walker Monsey McLeod Sarah Tonkin-Crine on behalf of the STEP-UP study team Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice Implementation Science Communications Implementation Behaviour change Qualitative Antibiotic prescribing Antimicrobial stewardship Antibiotic resistance |
| title | Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice |
| title_full | Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice |
| title_fullStr | Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice |
| title_full_unstemmed | Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice |
| title_short | Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice |
| title_sort | development of an intervention to support the implementation of evidence based strategies for optimising antibiotic prescribing in general practice |
| topic | Implementation Behaviour change Qualitative Antibiotic prescribing Antimicrobial stewardship Antibiotic resistance |
| url | https://doi.org/10.1186/s43058-021-00209-7 |
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