scholarly journals Improving Management of Respiratory Tract Infections in Community Pharmacies and Promoting Antimicrobial Stewardship: A Cluster Randomised Control Trial with a Self-Report Behavioural Questionnaire and Process Evaluation

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 44 ◽  
Author(s):  
Diane Ashiru-Oredope ◽  
Anne Doble ◽  
Tracey Thornley ◽  
Ayoub Saei ◽  
Natalie Gold ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antimicrobial Stewardship ◽  
Self Care ◽  
Self Report ◽  
Randomised Control Trial ◽  
Community Pharmacies ◽  
Pharmacy Staff ◽  
Cluster Randomised ◽  
Tract Infections ◽  
Cluster Randomised Control Trial

In England, 81% of all antibiotic prescriptions originate in primary care/community settings, of which up to 20% are thought to be inappropriate. Community pharmacies are often the first point of community contact for patients with suspected infections; providing an opportunity for community pharmacy teams to promote antimicrobial stewardship (AMS). The objective of the study was to improve the management of infections and antimicrobial stewardship in community pharmacies. The study methodology included a non-blinded cluster randomised control trial with pharmacy staff in 272 community pharmacies in England. The intervention arm received an AMS webinar and a patient facing respiratory tract infection (RTI) leaflet (TARGET TYI-RTI) for use in everyday practice for four weeks. The control arm received a webinar on how to participate in the study. The primary outcome was self-reported referrals to general practitioners (GPs). The secondary outcomes were; provision of self-care advice/ written information to patients, referrals to pharmacists, sign-posting to non-prescription medicines and common barriers and facilitators to advice-giving in community pharmacies. Ethics approval was granted by the Public Health England Research Ethics and Governance Group. 66.91% (182 of 272) of pharmacies provided 3649 patient consultation data reports across both arms. Use of the leaflet was associated with a lower likelihood of referrals to GPs for certain RTIs (p < 0.05) and a more frequent provision of self-care advice than the control (p = 0.06). Opportunities to deliver self-care advice were limited due to lack of time. Pharmacy staff had good motivation and capability for managing self-limiting infections but the opportunity to do so was a perceived barrier. Use of the TARGET leaflet facilitated pharmacy staff to give more self-care advice and decreased referrals to GPs.

scholarly journals Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 512 ◽  
Author(s):  
Lou Atkins ◽  
Tim Chadborn ◽  
Paulina Bondaronek ◽  
Diane Ashiru-Oredope ◽  
Elizabeth Beech ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Behavior Change ◽  
Mechanism Of Action ◽  
Antimicrobial Stewardship ◽  
Respiratory Tract Infections ◽  
Community Care ◽  
Theoretical Frameworks ◽  
Pharmacy Staff ◽  
Knowledge And Skills ◽  
Tract Infections

A major modifiable factor contributing to antimicrobial resistance (AMR) is inappropriate use and overuse of antimicrobials, such as antibiotics. This study aimed to describe the content and mechanism of action of antimicrobial stewardship (AMS) interventions to improve appropriate antibiotic use for respiratory tract infections (RTI) in primary and community care. This study also aimed to describe who these interventions were aimed at and the specific behaviors targeted for change. Evidence-based guidelines, peer-review publications, and infection experts were consulted to identify behaviors relevant to AMS for RTI in primary care and interventions to target these behaviors. Behavior change tools were used to describe the content of interventions. Theoretical frameworks were used to describe mechanisms of action. A total of 32 behaviors targeting six different groups were identified (patients; prescribers; community pharmacists; providers; commissioners; providers and commissioners). Thirty-nine interventions targeting the behaviors were identified (patients = 15, prescribers = 22, community pharmacy staff = 8, providers = 18, and commissioners = 18). Interventions targeted a mean of 5.8 behaviors (range 1–27). Influences on behavior most frequently targeted by interventions were psychological capability (knowledge and skills); reflective motivation (beliefs about consequences, intentions, social/professional role and identity); and physical opportunity (environmental context and resources). Interventions were most commonly characterized as achieving change by training, enabling, or educating and were delivered mainly through guidelines, service provision, and communications & marketing. Interventions included a mean of four Behavior Change Techniques (BCTs) (range 1–14). We identified little intervention content targeting automatic motivation and social opportunity influences on behavior. The majority of interventions focussed on education and training, which target knowledge and skills though the provision of instructions on how to perform a behavior and information about health consequences. Interventions could be refined with the inclusion of relevant BCTs, such as goal-setting and action planning (identified in only a few interventions), to translate instruction on how to perform a behavior into action. This study provides a platform to refine content and plan evaluation of antimicrobial stewardship interventions.

scholarly journals Feasibility of a community pharmacy antimicrobial stewardship intervention (PAMSI): an innovative approach to improve patients’ understanding of their antibiotics

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Rosalie Allison ◽  
Sarah Chapman ◽  
Philip Howard ◽  
Tracey Thornley ◽  
Diane Ashiru-Oredope ◽  
...  
Keyword(s):  
Side Effects ◽  
Community Pharmacy ◽  
Antimicrobial Stewardship ◽  
Self Care ◽  
Community Pharmacies ◽  
Symptom Duration ◽  
Intention To Use ◽  
Pharmacy Staff ◽  
Digital Format ◽  
Consumption Advice

Abstract Background Community pharmacy staff have an opportunity to play a pivotal role in antimicrobial stewardship (AMS) due to their expertise in medicines and accessibility to patients. Objectives To develop and test the feasibility of a pharmacy AMS intervention (PAMSI) to increase community pharmacy staff’s capability, opportunity and motivation to check antibiotic appropriateness and provide self-care and adherence advice when dispensing antibiotics. Methods The PAMSI was centred around an Antibiotic Checklist, completed by patients and pharmacy staff, to facilitate personalized advice to the patient, based on their reported knowledge. An educational webinar for staff and patient-facing materials were also developed. Staff and patients completing Antibiotic Checklists were invited to provide feedback via questionnaires. Results In February 2019, 12 community pharmacies in England trialled the intervention. Forty-three pharmacy staff evaluated the educational webinar and reported increases in their understanding, confidence, commitment and intention to use the tools provided to give adherence and self-care advice. Over 4 weeks, 931 Antibiotic Checklists were completed. Staff reported being more focused on giving advice and able to address patients’ knowledge gaps (mainly: likely symptom duration; alcohol and food consumption advice; possible side effects from antibiotics; returning unused antibiotics to the pharmacy), resulting in increased self-reported effective and meaningful conversations. Conclusions Implementation of a PAMSI is feasible and effectively promotes AMS. Pharmacy staff and commissioners should consider this within their AMS plans. An optional digital format of the Antibiotic Checklist should be explored, for patients who are not collecting their antibiotic prescriptions themselves, and to save printing costs.

scholarly journals Parent and Clinician Views of Managing Children with Symptoms of a Lower Respiratory Tract Infection and Their Influence upon Decisions to Take Part in a Placebo-Controlled Randomised Control Trial

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 356
Author(s):  
Catherine J. Woods ◽  
Zoe Morrice ◽  
Nick A. Francis ◽  
Paul Little ◽  
Theo Verheij ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Controlled Trial ◽  
Randomised Control Trial ◽  
Antibiotic Prescribing ◽  
Parent Attitudes ◽  
Telephone Interviews ◽  
Tract Infections ◽  
Interview Studies ◽  
Safety Netting

Children presenting with uncomplicated lower respiratory tract infections (LRTIs) commonly receive antibiotics despite public campaigns on antibiotic resistance. Qualitative interview studies were nested in a placebo-controlled trial of amoxicillin for LRTI in children. Thirty semi-structured telephone interviews were conducted with sixteen parents and fourteen clinicians to explore views of management and decisions to participate in the trial. All interviews were audio-recorded, transcribed and analysed using thematic analysis. Parents found it difficult to interpret symptoms and signs, and commonly used the type of cough (based on sound) to judge severity, highlighting the importance of better information to support parents. Provision of a clinical examination and reassurance regarding illness severity were key motivations for consulting. Many parents now acknowledge that antibiotics should only be used when ‘necessary’, and clinicians reported noticing a shift in parent attitudes with less demand for antibiotics and greater satisfaction with clinical assessment, reassurance and advice. Decisions to take part in the trial were influenced by the perceived risks associated with allocation to a placebo, and concerns about unnecessary use of antibiotics. Clear communication about self-management and safety-netting were identified as important when implementing ‘no antibiotic’ prescribing strategies to reassure parents and to support prescribing decisions.

Diagnostic and antimicrobial stewardship with molecular respiratory testing across the SHEA Research Network

2020 ◽  
pp. 1-4
Author(s):  
Kimberly C. Claeys ◽  
Daniel J. Morgan ◽  
Surbhi Leekha ◽  
Kaede V. Sullivan
Keyword(s):  
Respiratory Tract ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Real World ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Research Network ◽  
Lower Respiratory Tract Infections ◽  
Panel Testing ◽  
Tract Infections

This survey investigated diagnostic and antimicrobial stewardship practices related to molecular respiratory panel testing in adults with lower respiratory tract infections at acute care hospitals. Most respondents reported use of rapid respiratory panels, but related stewardship practices were uncommon and the real-world impact of respiratory panels were difficult to quantify.

scholarly journals Qualitative study using interviews and focus groups to explore the current and potential for antimicrobial stewardship in community pharmacy informed by the Theoretical Domains Framework

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e025101 ◽  
Author(s):  
Leah Ffion Jones ◽  
Rebecca Owens ◽  
Anna Sallis ◽  
Diane Ashiru-Oredope ◽  
Tracey Thornley ◽  
...  
Keyword(s):  
Focus Groups ◽  
Community Pharmacy ◽  
Antimicrobial Stewardship ◽  
Self Care ◽  
Intervention Development ◽  
Theoretical Domains Framework ◽  
Community Pharmacists ◽  
Pharmacy Staff ◽  
Barriers And Opportunities ◽  
The Impact

ObjectivesCommunity pharmacists and their staff have the potential to contribute to antimicrobial stewardship (AMS). However, their barriers and opportunities are not well understood. The aim was to investigate the experiences and perceptions of community pharmacists and their teams around AMS to inform intervention development.DesignInterviews and focus groups were used to explore the views of pharmacists, pharmacy staff, general practitioners (GPs), members of pharmacy organisations and commissioners. The questioning schedule was developed using the Theoretical Domains Framework which helped inform recommendations to facilitate AMS in community pharmacy.Results8 GPs, 28 pharmacists, 13 pharmacy staff, 6 representatives from pharmacy organisations in England and Wales, and 2 local stakeholders participated.Knowledge and skills both facilitated or hindered provision of self-care and compliance advice by different grades of pharmacy staff. Some staff were not aware of the impact of giving self-care and compliance advice to help control antimicrobial resistance (AMR). The pharmacy environment created barriers to AMS; this included lack of time of well-qualified staff leading to misinformation from underskilled staff to patients about the need for antibiotics or the need to visit the GP, this was exacerbated by lack of space. AMS activities were limited by absent diagnoses on antibiotic prescriptions.Several pharmacy staff felt that undertaking patient examinations, questioning the rationale for antibiotic prescriptions and performing audits would allow them to provide more tailored AMS advice.ConclusionsInterventions are required to overcome a lack of qualified staff, time and space to give patients AMS advice. Staff need to understand how self-care and antibiotic compliance advice can help control AMR. A multifaceted educational intervention including information for staff with feedback about the advice given may help. Indication for a prescription would enable pharmacists to provide more targeted antibiotic advice. Commissioners should consider the pharmacists’ role in examining patients, and giving advice about antibiotic prescriptions.

Improving general practice consultations for older people with asthma: a cluster randomised control trial

2009 ◽  
Vol 191 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Dianne P Goeman ◽  
Lena A Sanci ◽  
Simon L Scharf ◽  
Michael Bailey ◽  
Robyn E O’Hehir ◽  
...  
Keyword(s):  
General Practice ◽  
Older People ◽  
Randomised Control Trial ◽  
Cluster Randomised ◽  
Cluster Randomised Control Trial

scholarly journals Targeted Antimicrobial Stewardship Intervention for Inpatients With Viral respiratory tract infections

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Christopher F. Lowe ◽  
Michael Payne ◽  
Allison Kirkwood ◽  
Mark Hull ◽  
Victor Leung
Keyword(s):  
Respiratory Tract ◽  
Antimicrobial Stewardship ◽  
Respiratory Tract Infections ◽  
Tract Infections ◽  
Viral Respiratory

scholarly journals Vaccine Effectiveness Against Influenza-Associated Lower Respiratory Tract Infections in Hospitalized Adults, Louisville, Kentucky, 2010–2013

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Eric J Chow ◽  
Melissa A Rolfes ◽  
Ruth L Carrico ◽  
Stephen Furmanek ◽  
Julio A Ramirez ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Community Acquired Pneumonia ◽  
Vaccine Effectiveness ◽  
Self Report ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Radiographic Findings ◽  
History Of ◽  
Tract Infections

Abstract Background Preventing severe complications of influenza such as hospitalization is a public health priority; however, estimates of influenza vaccine effectiveness (VE) against influenza-associated acute lower respiratory tract infection (LRTI) hospitalizations are limited. We examined influenza VE against influenza-associated LRTIs in hospitalized adult patients. Methods We retrospectively analyzed data from a randomized trial of oseltamivir treatment in adults hospitalized with LRTI in Louisville, Kentucky, from 2010 to 2013. Patients were systematically tested for influenza at the time of enrollment. We estimated VE as 1 – the adjusted odds ratio (aOR) of antecedent vaccination in influenza-positives vs negatives × 100%. Vaccination status was obtained by patient self-report. Using logistic regression adjusting for age, sex, season, timing of illness, history of chronic lung disease, and activities of daily living, we estimated VE against hospitalized influenza-associated LRTIs and community-acquired pneumonia (CAP) with radiographic findings of infiltrate. Results Of 810 patients with LRTI (median age, 62 years), 184 (23%) were influenza-positive and 57% had radiographically confirmed CAP. Among influenza-positives and -negatives, respectively, 61% and 69% were vaccinated. Overall, 29% were hospitalized in the prior 90 days and &gt;80% had comorbidities. Influenza-negatives were more likely to have a history of chronic obstructive pulmonary disease than influenza-positives (59% vs 48%; P = .01), but baseline medical conditions were otherwise similar. Overall, VE was 35% (95% CI, 4% to 56%) against influenza-associated LRTI and 51% (95% CI, 13% to 72%) against influenza-associated radiographically confirmed CAP. Conclusions Vaccination reduced the risk of hospitalization for influenza-associated LRTI and radiographically confirmed CAP. Clinicians should maintain high rates of influenza vaccination to prevent severe influenza-associated complications.

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