Prioritizing research areas for antibiotic stewardship programmes in hospitals: a behavioural perspective consensus paper.
- Rzewuska M Health Services Research Unit, University of Aberdeen, Aberdeen, UK. Electronic address: magdalena.rzewuska@abdn.ac.uk.
- Charani E NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
- Clarkson JE Schools of Dentistry, University of Dundee, Dundee, UK.
- Davey PG Division of Population Health Sciences, Medical School, University of Dundee, Dundee, London, UK.
- Duncan EM Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
- Francis JJ School of Health Sciences, City University of London, London, UK.
- Gillies K Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
- Kern WV University of Freiburg Medical Center and Faculty of Medicine, Division of Infectious Diseases, Freiburg, Germany.
- Lorencatto F Centre for Behaviour Change, University College London, London, UK.
- Marwick CA Division of Population Health Sciences, Medical School, University of Dundee, Dundee, London, UK.
- McEwen J Ninewells Hospital, Dundee, UK.
- Möhler R Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Morris AM Sinai Health System, University Health Network and University of Toronto, Toronto, Canada.
- Ramsay CR Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
- Rogers Van Katwyk S School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- Skodvin B Norwegian Advisory Unit for Antibiotic Use in Hospitals, Haukeland University Hospital, Bergen, Norway.
- Smith I Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland.
- Suh KN Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada.
- Grimshaw JM Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, Canada.
- 2018-09-10
Published in:
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. - 2019
Antimicrobial stewardship
Behavioural approach
Multidisciplinary approach
Nominal group technique
Research priorities
Anti-Bacterial Agents
Antimicrobial Stewardship
Consensus
Hospitals
Humans
Infection Control
Practice Patterns, Physicians'
Research Design
English
SCOPE
Antibiotic stewardship programmes (ASPs) are necessary in hospitals to improve the judicious use of antibiotics. While ASPs require complex change of key behaviours on individual, team organization and policy levels, evidence from the behavioural sciences is underutilized in antibiotic stewardship studies across the world, including high-income countries (HICs). A consensus procedure was performed to propose research priority areas for optimizing effective implementation of ASPs in hospital settings using a behavioural perspective.
METHODS
A workgroup for behavioural approaches to ASPs was convened in response to the fourth call for leading expert network proposals by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). Eighteen clinical and academic specialists in antibiotic stewardship, implementation science and behaviour change from four HICs with publicly funded healthcare systems (e.g. Canada, Germany, Norway and the UK) met face-to-face to agree on broad research priority areas using a structured consensus method. Question addressed and recommendations: The consensus process assessing the ten identified research priority areas resulted in recommendations that need urgent scientific interest and funding to optimize effective implementation of ASPs for hospital inpatients in HICs with publicly funded healthcare systems. We suggest and detail behavioural science evidence-guided research efforts in the following areas: (a) comprehensively identifying barriers and facilitators to implementing ASPs and clinical recommendations intended to optimize antibiotic prescribing; (b) identifying actors ('who') and actions ('what needs to be done') of ASPs and clinical teams; (c) synthesizing available evidence to support future research and planning for ASPs; (d) specifying the activities in current ASPs with the purpose of defining a control group for comparison with new initiatives; (e) defining a balanced set of outcomes and measures to evaluate the effects of interventions focused on reducing unnecessary exposure to antibiotics; (f) conducting robust evaluations of ASPs with built-in process evaluations and fidelity assessments; (g) defining and designing ASPs; (h) establishing the evidence base for impact of ASPs on resistance; (i) investigating the role and impact of government and policy contexts on ASPs; and (j) understanding what matters to patients in ASPs in hospitals.
CONCLUSIONS
Assessment, revisions and updates of our priority-setting exercise should be considered at intervals of 2 years. To propose research priority areas in low- and middle-income countries, the methodology reported here could be applied.
Antibiotic stewardship programmes (ASPs) are necessary in hospitals to improve the judicious use of antibiotics. While ASPs require complex change of key behaviours on individual, team organization and policy levels, evidence from the behavioural sciences is underutilized in antibiotic stewardship studies across the world, including high-income countries (HICs). A consensus procedure was performed to propose research priority areas for optimizing effective implementation of ASPs in hospital settings using a behavioural perspective.
METHODS
A workgroup for behavioural approaches to ASPs was convened in response to the fourth call for leading expert network proposals by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). Eighteen clinical and academic specialists in antibiotic stewardship, implementation science and behaviour change from four HICs with publicly funded healthcare systems (e.g. Canada, Germany, Norway and the UK) met face-to-face to agree on broad research priority areas using a structured consensus method. Question addressed and recommendations: The consensus process assessing the ten identified research priority areas resulted in recommendations that need urgent scientific interest and funding to optimize effective implementation of ASPs for hospital inpatients in HICs with publicly funded healthcare systems. We suggest and detail behavioural science evidence-guided research efforts in the following areas: (a) comprehensively identifying barriers and facilitators to implementing ASPs and clinical recommendations intended to optimize antibiotic prescribing; (b) identifying actors ('who') and actions ('what needs to be done') of ASPs and clinical teams; (c) synthesizing available evidence to support future research and planning for ASPs; (d) specifying the activities in current ASPs with the purpose of defining a control group for comparison with new initiatives; (e) defining a balanced set of outcomes and measures to evaluate the effects of interventions focused on reducing unnecessary exposure to antibiotics; (f) conducting robust evaluations of ASPs with built-in process evaluations and fidelity assessments; (g) defining and designing ASPs; (h) establishing the evidence base for impact of ASPs on resistance; (i) investigating the role and impact of government and policy contexts on ASPs; and (j) understanding what matters to patients in ASPs in hospitals.
CONCLUSIONS
Assessment, revisions and updates of our priority-setting exercise should be considered at intervals of 2 years. To propose research priority areas in low- and middle-income countries, the methodology reported here could be applied.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1016/j.cmi.2018.08.020
- PMID 30195471
- Persistent URL
- https://sonar.ch/global/documents/93924
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