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Kien C, Daxenbichler J, Titscher V, Baenziger J, Klingenstein P, Naef R, Klerings I, Clack L, Fila J, Sommer I. Effectiveness of de-implementation of low-value healthcare practices: an overview of systematic reviews. Implement Sci 2024; 19:56. [PMID: 39103927 DOI: 10.1186/s13012-024-01384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/12/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Reducing low-value care (LVC) is crucial to improve the quality of patient care while increasing the efficient use of scarce healthcare resources. Recently, strategies to de-implement LVC have been mapped against the Expert Recommendation for Implementing Change (ERIC) compilation of strategies. However, such strategies' effectiveness across different healthcare practices has not been addressed. This overview of systematic reviews aimed to investigate the effectiveness of de-implementation initiatives and specific ERIC strategy clusters. METHODS We searched MEDLINE (Ovid), Epistemonikos.org and Scopus (Elsevier) from 1 January 2010 to 17 April 2023 and used additional search strategies to identify relevant systematic reviews (SRs). Two reviewers independently screened abstracts and full texts against a priori-defined criteria, assessed the SR quality and extracted pre-specified data. We created harvest plots to display the results. RESULTS Of 46 included SRs, 27 focused on drug treatments, such as antibiotics or opioids, twelve on laboratory tests or diagnostic imaging and seven on other healthcare practices. In categorising de-implementation strategies, SR authors applied different techniques: creating self-developed strategies (n = 12), focussing on specific de-implementation strategies (n = 14) and using published taxonomies (n = 12). Overall, 15 SRs provided evidence for the effectiveness of de-implementation interventions to reduce antibiotic and opioid utilisation. Reduced utilisation, albeit inconsistently significant, was documented in the use of antipsychotics and benzodiazepines, as well as in laboratory tests and diagnostic imaging. Strategies within the adapt and tailor to context, develop stakeholder interrelationships, and change infrastructure and workflow ERIC clusters led to a consistent reduction in LVC practices. CONCLUSION De-implementation initiatives were effective in reducing medication usage, and inconsistent significant reductions were observed for LVC laboratory tests and imaging. Notably, de-implementation clusters such as change infrastructure and workflow and develop stakeholder interrelationships emerged as the most encouraging avenues. Additionally, we provided suggestions to enhance SR quality, emphasising adherence to guidelines for synthesising complex interventions, prioritising appropriateness of care outcomes, documenting the development process of de-implementation initiatives and ensuring consistent reporting of applied de-implementation strategies. REGISTRATION OSF Open Science Framework 5ruzw.
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Affiliation(s)
- Christina Kien
- Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems (Danube University Krems), Dr.-Karl-Dorrek Straße 30, 3500, Krems a.d. Donau, Austria.
| | - Julia Daxenbichler
- Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems (Danube University Krems), Dr.-Karl-Dorrek Straße 30, 3500, Krems a.d. Donau, Austria
| | - Viktoria Titscher
- Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems (Danube University Krems), Dr.-Karl-Dorrek Straße 30, 3500, Krems a.d. Donau, Austria
| | - Julia Baenziger
- Institute for Implementation Science in Health Care, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Pauline Klingenstein
- Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems (Danube University Krems), Dr.-Karl-Dorrek Straße 30, 3500, Krems a.d. Donau, Austria
| | - Rahel Naef
- Institute for Implementation Science in Health Care, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Irma Klerings
- Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems (Danube University Krems), Dr.-Karl-Dorrek Straße 30, 3500, Krems a.d. Donau, Austria
| | - Lauren Clack
- Institute for Implementation Science in Health Care, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Julian Fila
- Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems (Danube University Krems), Dr.-Karl-Dorrek Straße 30, 3500, Krems a.d. Donau, Austria
| | - Isolde Sommer
- Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems (Danube University Krems), Dr.-Karl-Dorrek Straße 30, 3500, Krems a.d. Donau, Austria
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Kjelle E, Brandsæter IØ, Andersen ER, Hofmann B. Sustainability in healthcare by reducing low-value imaging - A narrative review. Radiography (Lond) 2024; 30 Suppl 1:30-34. [PMID: 38870571 DOI: 10.1016/j.radi.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES This narrative review aims to present the concept of value in imaging and explore why we conduct low-value procedures, how to reduce this wasteful use, and what we could gain from reducing low-value imaging. KEY FINDINGS Imaging of low value to the patient contributes to thousands of metric tons of CO2 emissions, costing several billion US dollars annually. With a 20% reduction in low-value imaging, we would reduce the waste of resources related to 7.2 million procedures and, at the same time, reduce the risk of incidentalomas, overdiagnosis, and overtreatment and reduce wait times for patients in need of imaging services of high value. Multi-component initiatives targeting barriers in all levels of society and healthcare are needed to reduce low-value imaging. Radiographers are key actors in medical imaging and can make substantial contributions to this effort by, together with the radiologists, referrers, and managers, ensuring that all imaging procedures conducted are sustainable along four dimensions of sustainability: value, cost, risk, and environment. CONCLUSION Efforts to secure sustainable imaging considering the four crucial dimensions (value, cost, radiation, and environment) should be made at all levels of society and healthcare, from governmental management to the individual healthcare worker. Radiographers are vital in obtaining sustainability to ensure only sustainable imaging procedures are conducted. IMPLICATIONS FOR PRACTICE When assessing the appropriateness of imaging procedures, we need to consider the environment, safety, effectiveness, and efficiency. To obtain this, we need a collective and coordinated effort locally, nationally, and internationally to deliver sustainable imaging services.
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Affiliation(s)
- E Kjelle
- Department of Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802 Gjøvik Norway; Department of Optometry, Radiography, and Lighting Design at the University of South-Eastern Norway (USN) at Drammen, Post Office Box 4, 3199 Borre, Norway.
| | - I Ø Brandsæter
- Department of Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802 Gjøvik Norway
| | - E R Andersen
- Department of Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802 Gjøvik Norway
| | - B Hofmann
- Department of Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802 Gjøvik Norway; Centre of Medical Ethics at the University of Oslo, Centre of Medical Ethics, Postbox 1130, Blindern, 0318 Oslo, Norway
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Wharton A, Jerome-D'Emilia B, Avallone M. Improving Antibiotic Overuse in Primary Care: A Multimodal Quality Improvement Project. CLIN NURSE SPEC 2024; 38:136-140. [PMID: 38625803 DOI: 10.1097/nur.0000000000000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
PURPOSE Antibiotic overuse has increased over time related to provider knowledge gaps about best practices, provider perception of patient expectations on receiving an antibiotic, possible pressure to see patients in a timely fashion, and concerns about decreased patient satisfaction when an antibiotic is not prescribed. The Centers for Disease Control and Prevention estimates that up to 30% of antibiotics are inappropriately prescribed in the outpatient setting. APPROACH This quality improvement project consisted of a multimodal approach to decrease inappropriate antibiotic prescribing for viral upper respiratory infections (URIs) by using provider education, passive patient education, and clinical decision support tools based on Centers for Disease Control and Prevention recommendations and the Be Antibiotic Aware tool. OUTCOMES Following implementation, there was an 11% decrease in viral URI antibiotic prescribing, from a rate of 29.33% to 18.33% following the multimodal implementation. CONCLUSION The use of evidence-based education and treatment guidelines was found to decrease inappropriate antibiotic prescribing for patients diagnosed with viral URIs.
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Affiliation(s)
- Anestasia Wharton
- Author Affiliations: Rutgers College of Nursing: Rutgers School of Nursing (Ms Wharton); and Rutgers University School of Nursing Camden, New Jersey (Drs Jerome-D'Emilia and Avallone)
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Alharbi AS, Alharbi MS, Almutairi KB, Alsaady RM, Alsaedi RM, Alhejaili RS. The Behavior of Primary Healthcare Doctors Toward Antibiotic Prescriptions for Upper Respiratory Tract Infections. Cureus 2024; 16:e53298. [PMID: 38435913 PMCID: PMC10906344 DOI: 10.7759/cureus.53298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Unnecessary prescription of antibiotics for patients with upper respiratory tract infections (URTIs) carries the potential risk to the development of bacterial resistance. OBJECTIVE This study aimed to investigate the behavior of primary healthcare (PHC) physicians toward an antibiotic prescription for URTI, Al-Madinah City, Saudi Arabia in 2021. METHODS A cross-sectional study was conducted at PHC centers in Al-Madinah City, Saudi Arabia. The study invited all physicians in the randomly selected 28 PHC centers to participate in the study. A master sheet adopted from a researcher done in the Asir region of Saudi Arabia about the pattern of prescription for URTI was used and included data about socio-demographic characteristics and data about presenting symptoms and signs of URTIs, the clinical diagnosis, type of medication prescribed, and duration of treatment also, included data about the factors that press physicians to prescribe antibiotics and their response. The questionnaire was filled out and returned back by 140 physicians. The collected data were analyzed and tabulated using appropriate statistical tests. RESULTS The mean age of the studied physicians was 34.4 ± 7.6 years (25-59 years). General practitioners and specialists were 66.4% and 33.6%, respectively. The prevalence of antibiotic prescriptions was 44.3%. The most prescribed antibiotics were amoxicillin (58.6%) and Augmentin (28.6%). Congested tonsils (87.1%), ear discharge (84.2%), and cervical lymphadenopathy (89.3%) were the most clinical factors that affected physicians' decisions to prescribe antibiotics for URTI. The non-clinical factors affecting physicians' decisions include patient request (52.8%) and press (28.5%), with no statistically significant difference detected between general practitioners and specialists. CONCLUSION The study findings indicate the need to develop intervention programs targeting physicians as well as the general population to decrease inappropriate antibiotic prescriptions in primary care centers.
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Affiliation(s)
- Ahlam S Alharbi
- Family and Community Medicine, Ministry of Health (MOH), Riyadh, SAU
| | | | | | | | - Rouz M Alsaedi
- Medicine and Surgery, Al-Rayan Colleges, Al Medinah, SAU
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Wilson JA, Fouweather T, Stocken DD, Homer T, Haighton C, Rousseau N, O'Hara J, Vale L, Wilson R, Carnell S, Wilkes S, Morrison J, Ah-See K, Carrie S, Hopkins C, Howe N, Hussain M, Lindley L, MacKenzie K, McSweeney L, Mehanna H, Raine C, Whelan RS, Sullivan F, von Wilamowitz-Moellendorff A, Teare D. Tonsillectomy compared with conservative management in patients over 16 years with recurrent sore throat: the NATTINA RCT and economic evaluation. Health Technol Assess 2023; 27:1-195. [PMID: 38204203 PMCID: PMC11017150 DOI: 10.3310/ykur3660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background The place of tonsillectomy in the management of sore throat in adults remains uncertain. Objectives To establish the clinical effectiveness and cost-effectiveness of tonsillectomy, compared with conservative management, for tonsillitis in adults, and to evaluate the impact of alternative sore throat patient pathways. Design This was a multicentre, randomised controlled trial comparing tonsillectomy with conservative management. The trial included a qualitative process evaluation and an economic evaluation. Setting The study took place at 27 NHS secondary care hospitals in Great Britain. Participants A total of 453 eligible participants with recurrent sore throats were recruited to the main trial. Interventions Patients were randomised on a 1 : 1 basis between tonsil dissection and conservative management (i.e. deferred surgery) using a variable block-stratified design, stratified by (1) centre and (2) severity. Main outcome measures The primary outcome measure was the total number of sore throat days over 24 months following randomisation. The secondary outcome measures were the number of sore throat episodes and five characteristics from Sore Throat Alert Return, describing severity of the sore throat, use of medications, time away from usual activities and the Short Form questionnaire-12 items. Additional secondary outcomes were the Tonsil Outcome Inventory-14 total and subscales and Short Form questionnaire-12 items 6 monthly. Evaluation of the impact of alternative sore throat patient pathways by observation and statistical modelling of outcomes against baseline severity, as assessed by Tonsil Outcome Inventory-14 score at recruitment. The incremental cost per sore throat day avoided, the incremental cost per quality-adjusted life-year gained based on responses to the Short Form questionnaire-12 items and the incremental net benefit based on costs and responses to a contingent valuation exercise. A qualitative process evaluation examined acceptability of trial processes and ramdomised arms. Results There was a median of 27 (interquartile range 12-52) sore throats over the 24-month follow-up. A smaller number of sore throats was reported in the tonsillectomy arm [median 23 (interquartile range 11-46)] than in the conservative management arm [median 30 (interquartile range 14-65)]. On an intention-to-treat basis, there were fewer sore throats in the tonsillectomy arm (incident rate ratio 0.53, 95% confidence interval 0.43 to 0.65). Sensitivity analyses confirmed this, as did the secondary outcomes. There were 52 episodes of post-operative haemorrhage reported in 231 participants undergoing tonsillectomy (22.5%). There were 47 re-admissions following tonsillectomy (20.3%), 35 relating to haemorrhage. On average, tonsillectomy was more costly and more effective in terms of both sore throat days avoided and quality-adjusted life-years gained. Tonsillectomy had a 100% probability of being considered cost-effective if the threshold for an additional quality-adjusted life year was £20,000. Tonsillectomy had a 69% probability of having a higher net benefit than conservative management. Trial processes were deemed to be acceptable. Patients who received surgery were unanimous in reporting to be happy to have received it. Limitations The decliners who provided data tended to have higher Tonsillectomy Outcome Inventory-14 scores than those willing to be randomised implying that patients with a higher burden of tonsillitis symptoms may have declined entry into the trial. Conclusions The tonsillectomy arm had fewer sore throat days over 24 months than the conservative management arm, and had a high probability of being considered cost-effective over the ranges considered. Further work should focus on when tonsillectomy should be offered. National Trial of Tonsillectomy IN Adults has assessed the effectiveness of tonsillectomy when offered for the current UK threshold of disease burden. Further research is required to define the minimum disease burden at which tonsillectomy becomes clinically effective and cost-effective. Trial registration This trial is registered as ISRCTN55284102. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/146/06) and is published in full in Health Technology Assessment; Vol. 27, No. 31. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Wilson
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Sonya Carnell
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | | | - Kim Ah-See
- Department of Otolaryngology Head and Neck Surgery, NHS Grampian, Aberdeen, UK
| | - Sean Carrie
- Ear, Nose and Throat Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Claire Hopkins
- Ear, Nose and Throat and Head and Neck Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicola Howe
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Kenneth MacKenzie
- Department of Ear, Nose and Throat Surgery, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lorraine McSweeney
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Christopher Raine
- Ear, Nose and Throat Department, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ruby Smith Whelan
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Frank Sullivan
- Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Bhatt S, Pathak R, Punetha VD, Punetha M. Recent advances and mechanism of antimicrobial efficacy of graphene-based materials: a review. JOURNAL OF MATERIALS SCIENCE 2023; 58:7839-7867. [PMID: 37200572 PMCID: PMC10166465 DOI: 10.1007/s10853-023-08534-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
Graphene-based materials have undergone substantial investigation in recent years owing to their wide array of physicochemical characteristics. Employment of these materials in the current state, where infectious illnesses caused by microbes have severely damaged human life, has found widespread application in combating fatal infectious diseases. These materials interact with the physicochemical characteristics of the microbial cell and alter or damage them. The current review is dedicated to molecular mechanisms underlying the antimicrobial property of graphene-based materials. Various physical and chemical mechanisms leading to cell membrane stress, mechanical wrapping, photo-thermal ablation as well as oxidative stress exerting antimicrobial effect have also been thoroughly discussed. Furthermore, an overview of the interactions of these materials with membrane lipids, proteins, and nucleic acids has been provided. A thorough understanding of discussed mechanisms and interactions is essential to develop extremely effective antimicrobial nanomaterial for application as an antimicrobial agent. Graphical abstract
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Affiliation(s)
- Shalini Bhatt
- 2D Materials and LASER Actuation Laboratory, Centre of Excellence for Research, PP Savani University, NH-8, Kosamba-Surat, Gujarat 394125 India
| | - Rakshit Pathak
- 2D Materials and LASER Actuation Laboratory, Centre of Excellence for Research, PP Savani University, NH-8, Kosamba-Surat, Gujarat 394125 India
| | - Vinay Deep Punetha
- 2D Materials and LASER Actuation Laboratory, Centre of Excellence for Research, PP Savani University, NH-8, Kosamba-Surat, Gujarat 394125 India
| | - Mayank Punetha
- 2D Materials and LASER Actuation Laboratory, Centre of Excellence for Research, PP Savani University, NH-8, Kosamba-Surat, Gujarat 394125 India
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Fallatah MS, Alzahrani AA, Alghamdi GS, Sadagah MM, Alkharji TM. Patient Beliefs on Antibiotic Prescribing in Primary Care: A Cross-Sectional Survey in Saudi Arabia. Cureus 2023; 15:e38254. [PMID: 37261169 PMCID: PMC10226837 DOI: 10.7759/cureus.38254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Background Antibiotic overuse is a critical global health issue, and patient attitudes and expectations play a significant role in the inappropriate use of antibiotics. Limited research has been conducted on patient knowledge, attitudes, and perceptions of antibiotic use in Saudi Arabia. This survey aimed to assess patients' knowledge and attitudes related to antibiotic use in Jeddah, Saudi Arabia. Methods A cross-sectional survey using a convenience sampling method was conducted in Saudi Arabia. An online self-administered questionnaire was used to collect demographic data, antibiotic knowledge, and attitudes. Results The study included 400 patients, with a mean age of 39 years and an equal gender distribution (54% female). Most participants (75%) had not used antibiotics in the past year. Patients demonstrated moderate knowledge about antibiotics, with 81% recognizing that antibiotics can cause side effects and 69% knowing that overuse can lead to resistance. However, only 44% knew that antibiotics are not effective for all infections, and only half (50%) knew that antibiotics work against bacteria, not viruses. Patients held mixed attitudes toward antibiotic prescribing, with 25% believing it was essential to take antibiotics for every infection and 44% believing healthcare providers should prescribe antibiotics for respiratory tract infections. Logistic regression analyses showed that patient expectations for antibiotic prescribing were strongly associated with inappropriate antibiotic use. In contrast, patient satisfaction with antibiotic prescribing was negatively associated with inappropriate antibiotic use. Lower health literacy levels were also associated with inappropriate antibiotic use. Conclusion The study underscores the need for interventions that promote patient education and communication to ensure appropriate antibiotic use in primary care. Patient attitudes and beliefs, such as their expectations for antibiotic prescribing and health literacy levels, were identified as significant predictors of inappropriate antibiotic use.
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Duan L, Liu C, Wang D, Lin R, Qian P, Zhang X, Liu C. The vicious cycle of the public's irrational use of antibiotics for upper respiratory tract infections: A mixed methods systematic review. Front Public Health 2022; 10:985188. [PMID: 36339167 PMCID: PMC9632431 DOI: 10.3389/fpubh.2022.985188] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/27/2022] [Indexed: 01/25/2023] Open
Abstract
Background The public's irrational use of antibiotics for upper respiratory tract infections (URTIs) is prevalent worldwide. This study aims to synthesize evidence on how people use antibiotics to treat URTIs, its prevalence and determinants. Methods A mixed methods systematic review was conducted using a convergent segregated approach. Relevant studies were searched from PubMed, Cochrane Library, Embase, and Web of Science. A qualitative analysis was initiated, exploring the public's antibiotic use experience for URTIS based on the Consumer Behavior Model (CBM). This was followed by a quantitative synthesis, tapping into the prevalence and predictors of public behavior in antibiotic usage for URTIs. The segregated syntheses complemented each other and were further integrated. Results A total of 86 studies were included: 48 quantitative, 30 qualitative, eight mixed methods studies. The included studies were conducted in Europe (n = 29), Asia (n = 27) and North America (n = 21), assessing the behaviors of patients (n = 46), their parents or caregivers (n = 31), or both (n = 9). Eleven themes emerged covering the six CBM stages: need recognition, information searching, alternative evaluation, antibiotic obtaining, antibiotic consumption, and post-consumption evaluation. The six stages reinforce each other, forming a vicious cycle. The high prevalence of the public's irrational use of antibiotics for URTIs is evident despite the high heterogeneity of the studies (ranging from 0.0 to 92.7%). The perceived seriousness of illness and misbelief in antibiotics were identified consistently across the studies as the major motivation driving the public's irrational use of antibiotics for URTIs. However, individual capacity (e.g., knowledge) and opportunity (e.g., contextual restriction) in reducing antibiotic use have mixed effect. Conclusion Systemic interventions concerning both supply and demand sides are warranted. The public needs to be educated about the appropriate management of URTIs and health care providers need to re-shape public attitudes toward antibiotic use for URTIs through communication and prescribing practices. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier: CRD42021266407.
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Affiliation(s)
- Lixia Duan
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Dan Wang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Rujiao Lin
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Pan Qian
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
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eHealthResp, a Digital Intervention to Improve Antibiotic Prescribing in Respiratory Infections: A Pilot Study. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081160. [PMID: 36013339 PMCID: PMC9410258 DOI: 10.3390/life12081160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022]
Abstract
The emergence of antibiotic resistance (ABR) is one of the most serious public health threats worldwide. The inappropriate use of antibiotics is considered the main determinant for the increase and development of ABR, contributing to a greater risk of therapeutic ineffectiveness, particularly within primary care context. Therefore, this pilot study aims to raise awareness and promote an adequate antibiotic use among physicians, through the evaluation of the eHealthResp platform, a digital intervention composed by an online course and a mobile application, to aid in the management of respiratory tract infections. The global validation of the eHealthResp platform was carried out by 12 physicians who explored and performed a quantitative and qualitative evaluation of the contents of the online course and mobile app. The global evaluation of the analyzed parameters was very positive, with the highest median scores being attributed to adequacy, correction, format, and trust of the eHealthResp platform. The qualitative feedback enhanced the contents’ relevance, clarity, and consolidation, as well as the effectiveness of the educational intervention against ABR. Overall, this study revealed that the eHealthResp may be regarded as an important e-health tool for the management of respiratory tract infections and improvement of antibiotic prescription practices among physicians.
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Mangione-Smith R, Robinson JD, Zhou C, Stout JW, Fiks AG, Shalowitz M, Gerber JS, Burges D, Hedrick B, Warren L, Grundmeier RW, Kronman MP, Shone LP, Steffes J, Wright M, Heritage J. Fidelity evaluation of the dialogue around respiratory illness treatment (DART) program communication training. PATIENT EDUCATION AND COUNSELING 2022; 105:2611-2616. [PMID: 35341612 PMCID: PMC9203931 DOI: 10.1016/j.pec.2022.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate receipt fidelity of communication training content included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory tract infections (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes. METHODS Parents were surveyed regarding clinician communication behaviors immediately after attending 1026 visits by children 6 months to < 11 years old diagnosed with ARTIs by 53 clinicians in 18 pediatric practices. Communication outcomes analyzed were whether clinicians: (A) provided both a combined (negative + positive) treatment recommendation and a contingency plan (full implementation); (B) provided either a combined treatment recommendation or a contingency plan (partial implementation); or (C) provided neither (no implementation). We used mixed effects multinomial logistic regression to determine whether these 3 communication outcomes changed between baseline and the time periods following each of 3 training modules. RESULTS After completing the communication training, the adjusted probability of clinicians fully implementing the intended communication behavior changes increased by an absolute 8.1% compared to baseline (95% Confidence Interval [CI]: 2.4%, 13.8%, p = .005). CONCLUSIONS Our findings support the receipt fidelity of the intervention's communication training content. PRACTICAL IMPLICATIONS Clinicians can be trained to implement communication behaviors that may aid in reducing antibiotic over-prescribing for ARTIs.
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Affiliation(s)
| | - Jeffrey D Robinson
- Department of Communication, Portland State University, Portland, OR, USA.
| | - Chuan Zhou
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA.
| | - James W Stout
- Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Alexander G Fiks
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Primary Care Research, American Academy of Pediatrics, IL, USA.
| | - Madeleine Shalowitz
- Department of Psychiatry and Behavioral Medicine, Rush University School of Medicine, Chicago, IL, USA.
| | - Jeffrey S Gerber
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Dennis Burges
- Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Benjamin Hedrick
- Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Louise Warren
- Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Robert W Grundmeier
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Matthew P Kronman
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA.
| | - Laura P Shone
- Primary Care Research, American Academy of Pediatrics, IL, USA.
| | | | - Margaret Wright
- Primary Care Research, American Academy of Pediatrics, IL, USA.
| | - John Heritage
- Department of Sociology, University of California Los Angeles, Los Angeles, CA, USA.
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11
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Guo H, Lim HY, Chow A. Health Information Orientation Profiles and Their Association with Knowledge of Antibiotic Use in a Population with Good Internet Access: A Cross-Sectional Study. Antibiotics (Basel) 2022; 11:769. [PMID: 35740175 PMCID: PMC9220153 DOI: 10.3390/antibiotics11060769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Poor knowledge of antibiotic use drives poor antibiotic practices, but little is known about the influence of health information orientation (HIO) on knowledge of antibiotic use in the general public. Methods: We conducted a nationally-representative population-wide cross-sectional study (November 2020−January 2021), on a proportionately stratified random sample of 2004 Singapore residents aged ≥21 years. Multivariable logistic regression analysis was performed to assess the association between HIO and knowledge of antibiotic use. Results: Forty percent of respondents had low-levels of HIO (LL-HIO); they tended to be younger, not currently married, and did not have family/friends working in the healthcare sector. Respondents with LL-HIO (aOR 1.82, 95% CI 1.32−2.51, p < 0.001) were 82% more likely to have poor knowledge of antibiotic use. In particular, older adults aged ≥50 years with LL-HIO (aOR 1.81, 95% CI [1.32−2.51], p < 0.001) were much more likely to have poor knowledge than their HL-HIO counterparts. They were also less likely to use the Internet to seek health information and had poor eHealth efficacy. Conclusion: LL-HIO is independently associated with poor knowledge of antibiotic use. Educational strategies on antibiotic use should disseminate a consistent message through both online and offline platforms, involving traditional and non-traditional healthcare and non-healthcare influencers.
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Affiliation(s)
- Huiling Guo
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (H.G.); (H.Y.L.)
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117459, Singapore
| | - Huai Yang Lim
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (H.G.); (H.Y.L.)
- Head Quarters, Singapore Armed Forces Medical Corps, 701 Transit Road, Singapore 778910, Singapore
| | - Angela Chow
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (H.G.); (H.Y.L.)
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117459, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore
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12
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King J, Powell-Jackson T, Hargreaves J, Makungu C, Goodman C. Pushy Patients Or Pushy Providers? Effect Of Patient Knowledge On Antibiotic Prescribing In Tanzania. Health Aff (Millwood) 2022; 41:911-920. [PMID: 35666967 DOI: 10.1377/hlthaff.2021.01782] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antimicrobial resistance is one of the most serious threats to global health, but little progress has been made in reversing its spread. Inappropriate use of antibiotics in humans is a major driver of antimicrobial resistance, and rates are high and growing in lower- and middle-income countries. Antibiotics are thought to be subject to supplier-induced demand, whereby providers prescribe them to patients who do not know they are unnecessary. We conducted a randomized field experiment in 227 private health facilities in Tanzania, with standardized patients presenting uncomplicated upper respiratory tract infection symptoms. Standardized patients were randomly assigned to express knowledge (informed) or not (uninformed) that antibiotics were not required to treat them. There was a very high rate of inappropriate antibiotic prescription, with 86.0 percent of informed standardized patients and 94.8 percent of uninformed standardized patients prescribed an antibiotic, for an adjusted difference of 7.8 percentage points between the groups. This small effect suggests that broader health systems factors are at play and that interventions should be aimed at systems, health facilities, and providers.
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Affiliation(s)
- Jessica King
- Jessica King , London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - James Hargreaves
- James Hargreaves, London School of Hygiene and Tropical Medicine
| | - Christina Makungu
- Christina Makungu, Ifakara Health Institute, Dar es Salaam, Tanzania
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13
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Rodríguez-Baño J, Retamar P. Unneeded antibiotics for acute respiratory infections in primary care: stop as early as possible. Clin Microbiol Infect 2021; 28:147-148. [PMID: 34823010 DOI: 10.1016/j.cmi.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/05/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena and Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain.
| | - Pilar Retamar
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena and Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain
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14
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Sánchez X, Orrico M, Morillo T, Manzano A, Jimbo R, Armijos L. Reducing unnecessary antibiotic prescription through implementation of a clinical guideline on self-limiting respiratory tract infections. PLoS One 2021; 16:e0249475. [PMID: 33793627 PMCID: PMC8016285 DOI: 10.1371/journal.pone.0249475] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical guidelines (CG) are used to reduce variability in practice when the scientific evidence is sparse or when multiple therapies are available. The development and implementation of evidence-based CG is intended to organize and provide the best available evidence to support clinical decision making in order to improve quality of care. Upper respiratory tract infections (URTI) are the leading cause of misuse of antibiotics and a CG may reduce the unnecessary antibiotic prescription. METHODS The aim of this quasi-experimental, before-after study was to analyze the short- and long-term effects of the implementation of a CG to decrease the rate of antibiotic prescription in URTI cases in the emergency department of a third level private hospital in Quito, Ecuador. The study included 444 patients with a main diagnosis of URTI. They were distributed in three groups: a baseline cohort 2011 (n = 114), a first post-implementation cohort 2011 (n = 114), and a later post-implementation cohort 2018 (n = 216). The implementation strategy consisted of five key steps: acceptance of the need for implementation of the CG, dissemination of the CG, an educational campaign, constant feedback, and sustainability of the strategy through continuous training. RESULTS The results of this study show a 42.90% of antibiotic prescription rate before the CG implementation. After the implementation of the CG, the prescription rate of antibiotics was significantly reduced by 24.5% (42.9% vs 18.4%, p<0.0001) and the appropriate antibiotic prescription rate was significantly increased by 44.2% (22.4% vs 66.6%, p<0.0001) in the first post-implementation cohort 2011. There was not a significant difference in antibiotic prescription rate and appropriate antibiotic prescription rate between two post-implementation cohorts: 18.4% vs 25.9% (p = 0.125) and 66.6% vs 50% (p = 0.191), respectively. CONCLUSIONS The implementation of CGs decreases the rate of antibiotic prescription in URTI cases. The results are remarkable after early implementation, but the effect persists over time. The emphasis must shift from guideline development to strategy implementation.
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Affiliation(s)
- Xavier Sánchez
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Universidad Alcalá de Henares, Madrid, España
| | - María Orrico
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Toa Morillo
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Andrea Manzano
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Ruth Jimbo
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Universidad Alcalá de Henares, Madrid, España
| | - Luciana Armijos
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
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15
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Seifi T, Kamali AR. Anti-pathogenic activity of graphene nanomaterials: A review. Colloids Surf B Biointerfaces 2020; 199:111509. [PMID: 33340933 DOI: 10.1016/j.colsurfb.2020.111509] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 12/12/2022]
Abstract
Graphene and its derivatives are promising candidates for a variety of biological applications, among which, their anti-pathogenic properties are highly attractive due to the outstanding physicochemical characteristics of these novel nanomaterials. The antibacterial, antiviral and antifungal performances of graphene are increasingly becoming more important due to the pathogen's resistance to existing drugs. Despite this, the factors influencing the antibacterial activity of graphene nanomaterials, and consequently, the mechanisms involved are still controversial. This review aims to systematically summarize the literature, discussing various factors that affect the antibacterial performance of graphene materials, including the shape, size, functional group and the electrical conductivity of graphene flakes, as well as the concentration, contact time and the pH value of the graphene suspensions used in related microbial tests. We discuss the possible surface and edge interactions between bacterial cells and graphene nanomaterials, which cause antibacterial effects such as membrane/oxidative/photothermal stresses, charge transfer, entrapment and self-killing phenomena. This article reviews the anti-pathogenic activity of graphene nanomaterials, comprising their antibacterial, antiviral, antifungal and biofilm-forming performance, with an emphasis on the antibacterial mechanisms involved.
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Affiliation(s)
- Tahereh Seifi
- Energy and Environmental Materials Research Centre (E(2)MC), School of Metallurgy, Northeastern University, Shenyang, 110819, China
| | - Ali Reza Kamali
- Energy and Environmental Materials Research Centre (E(2)MC), School of Metallurgy, Northeastern University, Shenyang, 110819, China.
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16
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Van Hecke O, Lee JJ, Butler CC, Moore M, Tonkin-Crine S. Using evidence-based infographics to increase parents' understanding about antibiotic use and antibiotic resistance: a proof-of-concept study. JAC Antimicrob Resist 2020; 2:dlaa102. [PMID: 34223054 PMCID: PMC8210337 DOI: 10.1093/jacamr/dlaa102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/19/2020] [Indexed: 11/12/2022] Open
Abstract
Background Communities need to see antibiotic stewardship campaigns as relevant to enhance understanding of antibiotic use and influence health-seeking behaviour. Yet, campaigns have often not sought input from the public in their development. Objectives To co-produce evidenced-based infographics (EBIs) about antibiotics for common childhood infections and to evaluate their effectiveness at increasing parents’ understanding of antibiotic use. Methods A mixed-methods study with three phases. Phase 1 identified and summarized evidence of antibiotic use for three childhood infections (sore throat, acute cough and otitis media). In phase 2, we co-designed a series of prototype EBIs with parents and a graphic design team (focus groups). Thematic analysis was used to analyse data. Phase 3 assessed the effect of EBIs on parents’ understanding of antibiotic use for the three infections using a national online survey in the UK. Results We iteratively co-produced 10 prototype EBIs. Parents found the evidence displayed in the EBIs novel and relevant to their families. Parents did not favour EBIs that were too medically focused. Parents preferred one health message per EBI. We included eight EBIs in a national survey of parents (n = 998). EBIs improved knowledge by more than a third across the board (34%, IQR 20%–46%, P < 0.001). Respondents confirmed that EBIs were novel and potentially useful, corroborating our focus groups findings. Conclusions Co-designed EBIs have the potential to succinctly change parents’ perceptions about antibiotics for acute respiratory tract infections in children. Further research should test EBIs in real-world settings to assess their reach as a potential public-facing intervention.
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Affiliation(s)
- Oliver Van Hecke
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Joseph J Lee
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Chris C Butler
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Michael Moore
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
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