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Chater A, Family H, Lim R, Courtenay M. Influences on antibiotic prescribing by non-medical prescribers for respiratory tract infections: a systematic review using the theoretical domains framework. J Antimicrob Chemother 2021; 75:3458-3470. [PMID: 32766694 DOI: 10.1093/jac/dkaa335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/30/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The need to conserve antibiotic efficacy, through the management of respiratory tract infections (RTIs) without recourse to antibiotics, is a global priority. A key target for interventions is the antibiotic prescribing behaviour of healthcare professionals including non-medical prescribers (NMPs: nurses, pharmacists, paramedics, physiotherapists) who manage these infections. OBJECTIVES To identify what evidence exists regarding the influences on NMPs' antimicrobial prescribing behaviour and analyse the operationalization of the identified drivers of behaviour using the Theoretical Domains Framework (TDF). METHODS The search strategy was applied across six electronic bibliographic databases (eligibility criteria included: original studies; written in English and published before July 2019; non-medical prescribers as participants; and looked at influences on prescribing patterns of antibiotics for RTIs). Study characteristics, influences on appropriate antibiotic prescribing and intervention content to enhance appropriate antibiotic prescribing were independently extracted and mapped to the TDF. RESULTS The search retrieved 490 original articles. Eight papers met the review criteria. Key issues centred around strategies for managing challenges experienced during consultations, managing patient concerns, peer support and wider public awareness of antimicrobial resistance. The two most common TDF domains highlighted as influences on prescribing behaviour, represented in all studies, were social influences and beliefs about consequences. CONCLUSIONS The core domains highlighted as influential to appropriate antibiotic prescribing should be considered when developing future interventions. Focus should be given to overcoming social influences (patients, other clinicians) and reassurance in relation to beliefs about negative consequences (missing something that could lead to a negative outcome).
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Affiliation(s)
- Angel Chater
- Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford MK41 9EA, UK.,University College London School of Pharmacy, London WC1H 9JP, UK
| | - Hannah Family
- Bristol Medical School, University of Bristol, BS8 2BN, UK
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Rietbergen T, Spoon D, Brunsveld-Reinders AH, Schoones JW, Huis A, Heinen M, Persoon A, van Dijk M, Vermeulen H, Ista E, van Bodegom-Vos L. Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis. Implement Sci 2020; 15:38. [PMID: 32450898 PMCID: PMC7249362 DOI: 10.1186/s13012-020-00995-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/29/2020] [Indexed: 11/11/2022] Open
Abstract
Background In the last decade, there is an increasing focus on detecting and compiling lists of low-value nursing procedures. However, less is known about effective de-implementation strategies for these procedures. Therefore, the aim of this systematic review was to summarize the evidence of effective strategies to de-implement low-value nursing procedures. Methods PubMed, Embase, Emcare, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched till January 2020. Additionally, reference lists and citations of the included studies were searched. Studies were included that described de-implementation of low-value nursing procedures, i.e., procedures, test, or drug orders by nurses or nurse practitioners. PRISMA guideline was followed, and the ‘Cochrane Effective Practice and Organisation of Care’ (EPOC) taxonomy was used to categorize de-implementation strategies. A meta-analysis was performed for the volume of low-value nursing procedures in controlled studies, and Mantel–Haenszel risk ratios (95% CI) were calculated using a random effects model. Results Twenty-seven studies were included in this review. Studies used a (cluster) randomized design (n = 10), controlled before-after design (n = 5), and an uncontrolled before-after design (n = 12). Low-value nursing procedures performed by nurses and/or nurse specialists that were found in this study were restraint use (n = 20), inappropriate antibiotic prescribing (n = 3), indwelling or unnecessary urinary catheters use (n = 2), ordering unnecessary liver function tests (n = 1), and unnecessary antipsychotic prescribing (n = 1). Fourteen studies showed a significant reduction in low-value nursing procedures. Thirteen of these 14 studies included an educational component within their de-implementation strategy. Twelve controlled studies were included in the meta-analysis. Subgroup analyses for study design showed no statistically significant subgroup effect for the volume of low-value nursing procedures (p = 0.20). Conclusions The majority of the studies with a positive significant effect used a de-implementation strategy with an educational component. Unfortunately, no conclusions can be drawn about which strategy is most effective for reducing low-value nursing care due to a high level of heterogeneity and a lack of studies. We recommend that future studies better report the effects of de-implementation strategies and perform a process evaluation to determine to which extent the strategy has been used. Trial registration The review is registered in Prospero (CRD42018105100).
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Affiliation(s)
- Tessa Rietbergen
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Denise Spoon
- Department of Internal Medicine, Nursing Science, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Jan W Schoones
- Leiden University Medical Center, Walaeus Library, Leiden, The Netherlands
| | - Anita Huis
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maud Heinen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anke Persoon
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Nursing Science, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Hester Vermeulen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Nursing Science, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
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