Influences on independent nurse prescribers' antimicrobial prescribing behaviour: a systematic review

2016 ◽  
Vol 25 (9-10) ◽  
pp. 1206-1217 ◽  
Author(s):  
Valerie Ness ◽  
Lesley Price ◽  
Kay Currie ◽  
Jacqueline Reilly
Keyword(s):  
Systematic Review ◽  
Antimicrobial Prescribing ◽  
Prescribing Behaviour

scholarly journals Understanding surgical antimicrobial prescribing behaviour in the hospital setting: a systematic review and meta-ethnography protocol

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Hazel Parker ◽  
Julia Frost ◽  
Nicky Britten ◽  
Sophie Robinson ◽  
Karen Mattick
Keyword(s):  
Systematic Review ◽  
Contextual Factors ◽  
Research Question ◽  
Hospital Setting ◽  
Cochrane Library ◽  
Phase Method ◽  
Clear Understanding ◽  
Antimicrobial Prescribing ◽  
Key Concepts ◽  
Prescribing Behaviour

Abstract Background Surgical specialities use extensive amounts of antimicrobials, and misuse has been widely reported, making them a key target for antimicrobial stewardship initiatives. Interventions informed by, and tailored to, a clear understanding of the contextual barriers to appropriate antimicrobial use are more likely to successfully improve practice. However, this approach has been under utilised. Our aim is to synthesise qualitative studies on surgical antimicrobial prescribing behaviour (APB) in hospital settings to explain how and why contextual factors act and interact to influence APB amongst surgical teams. We will develop new theory to advance understanding and identify knowledge gaps to inform further research. Methods The meta-ethnography will follow the seven-phase method described by Noblit and Hare. We will conduct a comprehensive search using eight databases (AMED, CINAHL, EMBASE, MEDLINE, MEDLINE-in-process, Web of Science, Cochrane Library and PsycINFO) with no date restrictions; forwards and backwards citation searches; and contacting first authors of relevant papers. Studies will be dual screened and included if they use recognised qualitative methods and analysis; focus on contextual factors associated with surgical APB within hospital settings; are available in full in English; and are relevant to the research question. Any disagreements between reviewers will be resolved through discussion to reach consensus. Included studies will be read repeatedly to illuminate key concepts and the relationship between key concepts across studies. Then, key concepts will be sorted into conceptual categories or ‘piles’ which will be further abstracted to form a conceptual framework explaining surgical APB. During the synthesis, emerging interpretations will be discussed with stakeholders (including authors of included studies where possible; surgical and stewardship practitioners; and patient representatives) to ensure new knowledge is meaningful. Discussion This research has several strengths: (1) the protocol has been written with reference to established guidance maximising rigour and transparency; (2) the multi-disciplinary research team bring varied interpretative repertoires and relevant methodological skills; and (3) stakeholders will be involved to ensure that findings are relevant, and disseminated via suitable channels, to support improved patient care. Systematic review registration PROSPERO CRD42020184343

scholarly journals Understanding surgical antimicrobial prescribing behaviour in the hospital setting: a systematic review and meta-ethnography protocol

2020 ◽  
Author(s):  
Hazel Parker ◽  
Julia Frost ◽  
Nicky Britten ◽  
Sophie Robinson ◽  
Karen Mattick
Keyword(s):  
Systematic Review ◽  
Contextual Factors ◽  
Research Question ◽  
Hospital Setting ◽  
Cochrane Library ◽  
Phase Method ◽  
Clear Understanding ◽  
Antimicrobial Prescribing ◽  
Key Concepts ◽  
Prescribing Behaviour

Abstract Background Surgical specialities use extensive amounts of antimicrobials, and misuse has been widely reported, making them a key target for antimicrobial stewardship initiatives. Interventions informed by, and tailored to, a clear understanding of the contextual barriers to appropriate antimicrobial use are more likely to successfully improve practice. However, this approach has been under-utilised. Our aim is to synthesise qualitative studies on surgical antimicrobial prescribing behaviour (APB) in hospital settings to explain how and why contextual factors act and interact to influence APB among surgical teams. We will develop new theory to advance understanding and identify knowledge gaps to inform further research. Methods The meta-ethnography will follow the seven-phase method described by Noblit and Hare. We will conduct a comprehensive search using eight databases (AMED, CINAHL, EMBASE, MEDLINE, MEDLINE-in-process, Web of Science, Cochrane Library and PsycINFO) with no date restrictions; forwards and backwards citation searches; and contacting first authors of relevant papers. Studies will be dual screened and included if they use recognised qualitative methods and analysis; focus on contextual factors associated with surgical APB within hospital settings; are available in full in English; and are relevant to the research question. Any disagreements between reviewers will be resolved through discussion to reach consensus. Included studies will be read repeatedly to illuminate key concepts and the relationship between key concepts across studies. Then, key concepts will be sorted into conceptual categories or ‘piles’ which will be further abstracted to form a conceptual framework explaining surgical APB. During the synthesis, emerging interpretations will be discussed with stakeholders (including authors of included studies where possible; surgical and stewardship practitioners; and patient representatives) to ensure new knowledge is meaningful. Discussion This research has several strengths: (1) the protocol has been written with reference to established guidance maximising rigour and transparency; (2) the multi-disciplinary research team bring varied interpretative repertoires and relevant methodological skills; and (3) stakeholders will be involved to ensure that findings are relevant, and disseminated via suitable channels, to support improved patient care. Systematic review registrationThe meta-ethnography has been registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number CRD42020184343.

scholarly journals Understanding Surgical Antimicrobial Prescribing Behaviour in the Hospital Setting: A Systematic Review and Meta-ethnography Protocol

2020 ◽  
Author(s):  
Hazel M Parker ◽  
Julia Frost ◽  
Nicky Britten ◽  
Sophie Robinson ◽  
Karen Mattick
Keyword(s):  
Systematic Review ◽  
Contextual Factors ◽  
Research Question ◽  
Hospital Setting ◽  
Cochrane Library ◽  
Phase Method ◽  
Clear Understanding ◽  
Antimicrobial Prescribing ◽  
Key Concepts ◽  
Prescribing Behaviour

Abstract Background Surgical specialities use extensive amounts of antimicrobials, and misuse has been widely reported, making them a key target for antimicrobial stewardship initiatives. Interventions informed by, and tailored to, a clear understanding of the contextual barriers to appropriate antimicrobial use are more likely to successfully improve practice. However, this approach has been under-utilised. Our aim is to synthesise qualitative studies on surgical antimicrobial prescribing behaviour (APB) in hospital settings to explain how and why contextual factors act and interact to influence APB among surgical teams. We will develop new theory to advance understanding and identify knowledge gaps to inform further research. Methods The meta-ethnography will follow the seven-phase method described by Noblit and Hare. We will conduct a comprehensive search using eight databases (AMED, CINAHL, EMBASE, MEDLINE, MEDLINE-in-process, Web of Science, Cochrane Library and PsycINFO) with no date restrictions; forwards and backwards citation searches; and contacting first authors of relevant papers. Studies will be dual screened and included if they use recognised qualitative methods and analysis; focus on contextual factors associated with surgical APB within hospital settings; are available in full in English; and are relevant to the research question. Any disagreements between reviewers will be resolved through discussion to reach consensus. Included studies will be read repeatedly to illuminate key concepts and the relationship between key concepts across studies. Then, key concepts will be sorted into conceptual categories or ‘piles’ which will be further abstracted to form a conceptual framework explaining surgical APB. During the synthesis, emerging interpretations will be discussed with stakeholders (including authors of included studies where possible; surgical and stewardship practitioners; and patient representatives) to ensure new knowledge is meaningful. Discussion This research has several strengths: (1) the protocol has been written with reference to established guidance maximising rigour and transparency; (2) the multi-disciplinary research team bring varied interpretative repertoires and relevant methodological skills; and (3) stakeholders will be involved to ensure that findings are relevant, and disseminated via suitable channels, to support improved patient care. Systematic review registration The meta-ethnography has been registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number CRD42020184343.

scholarly journals Using the Theoretical Domains Framework to investigate clinicians’ behavioural determinants of antimicrobial prescribing in Qatar

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i20-i22
Author(s):  
H Talkhan ◽  
D Stewart ◽  
T McIntosh ◽  
H Ziglam ◽  
P V Abdulrouf ◽  
...  
Keyword(s):  
Systematic Review ◽  
Scale Score ◽  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Free Text ◽  
Behaviour Change Interventions ◽  
Antimicrobial Prescribing ◽  
Behavioural Determinants ◽  
Inferential Analysis ◽  
Determinants Of Implementation

Abstract Introduction A recent systematic review by Talkhan et al demonstrated the need for theoretically based behaviour change interventions in this area. [1] For development of such complex interventions, emphasis should be placed on using theory to systematically identify behavioural determinants of antimicrobial prescribing. Aim To identify and quantify clinicians’ behavioural determinants of antimicrobial prescribing in Qatar. Methods This cross-sectional survey is part of a multi-phase explanatory, sequential mixed methods PhD project in Qatar. Questionnaires were distributed (online and paper based) to all doctors (~4,000) and pharmacists (~400) within Hamad Medical Corporation (HMC, the main healthcare provider). The questionnaire was developed with reference to the Determinants of Implementation Behaviour Questionnaire (a generic questionnaire derived from the 14 theoretical domains of the Theoretical Domains Framework, TDF). [2] Each item was presented as a 5-point Likert scale (scored 5=Strongly agree to 1=Strongly disagree). Personal and practice demographics were also collected for data contextualisation. The draft questionnaire was reviewed for face/content validity by an expert panel of six researchers in Qatar and the UK with experience in the use of the TDF, followed by ‘Think aloud’ testing and piloting. Analysis investigated the behavioural determinants and influential factors through descriptive, principal component analysis (PCA) and inferential analysis. Ethics approval was granted from a UK university and HMC. Results In total, 535 responses were received, 339 (63.4%) from doctors and 196 (36.6%) from pharmacists. Respondents were predominantly male, 346 (64.7%). Just over half (n=285, 53.3%) had ≤ 5 years’ experience as health professionals. PCA showed a three component (C) solution with components incorporating a number of questionnaire items labelled: ‘Guidelines compliance’ (C1 with 8 items), ‘Influences on prescribing’ (C2 with 7 items) and ‘Self-efficacy’ (C3 with 5 items) in prescribing/recommendation activity. A scale score for each respondent was calculated through summation of Likert scores for the relevant questionnaire items within each component. These scales had high internal reliability (Cronbach’s alpha all >0.7) showing consistency in response between component items indicating statistical appropriateness for developing scales. The median score (possible scale range, midpoint) for each scale was C1, 32 (8 to 40, 24), C2, 26 (7 to 35, 21) and C3, 20, (5 to 25, 15). By way of example Table 1 shows levels of agreement for items in C2. This shows lower levels of agreement than C1 scale with the median scale score (26) closer to the midpoint (21) indicating that respondents had less positive views. Inferential analysis using these scale scores and free text analysis is in progress. Conclusion A theoretical basis was used throughout providing insights to behavioural determinants for the development of a theory-based behaviour change intervention. Preliminary results suggest that social influences, staff development and quality monitoring may be useful targets for behaviour change interventions to improve antimicrobial prescribing practice. Limitations include potential social desirability bias and focus on one healthcare organisation/country in the Middle East which may limit generalisability of findings. More in-depth exploration is required to select and test appropriate linked theory-based behaviour change techniques. References 1. Talkhan H, Stewart D, McIntosh T, Ziglam H Palli Valapila, A; Moza Sulaiman H, Diab M, Cunningham S. The use of theory in the development and evalu​ation of behaviour change interventions to improve antimicrobial prescribing: a systematic review. J Antimicrob Chemother. 2020;75(9):2394–2410, Available from https://doi.org/10.1093/jac/dkaa154 [Accessed 12 Oct 2020]. 2. Huijg JM, Gebhardt WA, Dusseldorp E, Verheijden MW, van der Zouwe N, Middelkoop BJ, Crone MR. Measuring determinants of implementation behaviour: psychometric properties of a questionnaire based on the Theoretical Domains Framework. Implement. Sci. 2014;9(1):33.

Influences on antimicrobial prescribing behaviour of veterinary practitioners in cattle practice in Ireland

2012 ◽  
Vol 172 (1) ◽  
pp. 14-14 ◽  
Author(s):  
J. F. Gibbons ◽  
F. Boland ◽  
J. F. Buckley ◽  
F. Butler ◽  
J. Egan ◽  
...  
Keyword(s):  
Antimicrobial Prescribing ◽  
Prescribing Behaviour

scholarly journals Behavior Change Strategies to Influence Antimicrobial Prescribing in Acute Care: A Systematic Review

2011 ◽  
Vol 53 (7) ◽  
pp. 651-662 ◽  
Author(s):  
Esmita Charani ◽  
Rachel Edwards ◽  
Nick Sevdalis ◽  
Banos Alexandrou ◽  
Eleanor Sibley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Behavior Change ◽  
Acute Care ◽  
Change Strategies ◽  
Antimicrobial Prescribing

Understanding physician antibiotic prescribing behaviour: a systematic review of qualitative studies

2013 ◽  
Vol 41 (3) ◽  
pp. 203-212 ◽  
Author(s):  
António Teixeira Rodrigues ◽  
Fátima Roque ◽  
Amílcar Falcão ◽  
Adolfo Figueiras ◽  
Maria Teresa Herdeiro
Keyword(s):  
Systematic Review ◽  
Qualitative Studies ◽  
Antibiotic Prescribing ◽  
Prescribing Behaviour

scholarly journals A Multidisciplinary Hospital-based Antimicrobial Use Program: Impact on Hospital Pharmacy Expenditures and Drug Use

1996 ◽  
Vol 7 (2) ◽  
pp. 104-109 ◽  
Author(s):  
Suzette Salama ◽  
Coleman Rotstein ◽  
Lionel Mandell
Keyword(s):  
Quality Assurance ◽  
Hospital Pharmacy ◽  
Cost Savings ◽  
Antimicrobial Use ◽  
Canadian Hospital ◽  
Drug Budget ◽  
Program Impact ◽  
Use Patterns ◽  
Antimicrobial Prescribing ◽  
Prescribing Behaviour

The authors’ hospital embarked on a three-component, multidisciplinary, hospital-based antimicrobial use program to cut costs and reduce inappropriate antimicrobial use. Initially, antimicrobial use patterns and costs were monitored for 12 months. For the next two years, an antimicrobial use program was implemented consisting of three strategies: automatic therapeutic interchanges; antimicrobial restriction policies; and parenteral to oral conversion. The program resulted in a reduction in the antimicrobial portion of the total pharmacy drug budget from 41.6% to 28.2%. Simultaneously, the average cost per dose per patient day dropped from $11.88 in 1991 to $10.16 in 1994. Overall, mean monthly acquisition cost savings rose from $6,810 in 1992 to $27,590 in 1994. This study demonstrates that a multidisciplinary antimicrobial use program in a Canadian hospital can effect dramatic cost savings and serve as a quality assurance activity of physician antimicrobial prescribing behaviour.

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