Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review

Keller, Sara C.; Cosgrove, Sara E.; Miller, Melissa A.; Sateia, Heather F.; Szymczak, Julie; Gürses, Ayşe P.; Linder, Jeffrey A.

doi:10.3122/jabfm.2018.03.170225

Cited by 34 publications

(55 citation statements)

References 78 publications

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“…Clinic Work Flow Analyses [26] • Identifying stewardship opportunities in the process of patient flow through each clinic from requesting an appointment, the various staff encountered, their roles in encounters suspected of being an infection, and different places in the clinic (reception, office assistant or nursing station, clinical exam room) the patient moved through Audit and Feedback Reports [27,28] • Clinic records were audited every 3 months to abstract antimicrobial prescribing information for every respiratory and urinary tract infection (women only) identified. 1-page reports detailed overall prescribing rates compared to the other clinics, and antimicrobial choices for the four targeted infections…”

Section: Individual Intervention Brief Descriptionmentioning

confidence: 99%

Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study

et al. 2020

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The overuse of antimicrobials in primary care can be linked to an increased risk of antimicrobial-resistant bacteria for individual patients. Although there are promising signs of the benefits associated with Antimicrobial Stewardship Programs (ASPs) in hospitals and long-term care settings, there is limited knowledge in primary care settings and how to implement ASPs in these settings is unclear. In this context, a qualitative study was undertaken to explore the perceptions of primary care prescribers of the usefulness, feasibility, and experiences associated with the implementation of a pilot community-focused ASP intervention in three primary care clinics. Qualitative interviews were conducted with primary care clinicians, including local ASP champions, prescribers, and other primary health care team members, while they participated in an ASP initiative within one of three primary care clinics. An iterative conventional content analyses approach was used to analyze the transcribed interviews. Themes emerged around the key enablers and barriers associated with ASP implementation. Study findings point to key insights relevant to the scalability of community ASP activities with primary care providers.

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Section: Individual Intervention Brief Descriptionmentioning

confidence: 99%

Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study

et al. 2020

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“…We used IBM SPSS statistic version 24 (SPSS) and Microsoft excel for data analysis. Qualitative data were analysed by using a framework of human factor engineering model, Systems Engineering Initiative for Patient Safety (SEIPS 2.0) [45,46].…”

Section: Discussionmentioning

confidence: 99%

A Nationwide Survey of Australian General Practitioners on Antimicrobial Stewardship: Awareness, Uptake, Collaboration with Pharmacists and Improvement Strategies

et al. 2020

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Implementing antimicrobial stewardship (AMS) programs is central to optimise antimicrobial use in primary care. This study aims to assess general practitioners’ (GPs’) awareness of AMS, uptake of AMS strategies, attitudes towards GP–pharmacist collaboration in AMS and future AMS improvement strategies. A paper-based survey of nationally representative GPs across Australia was conducted in 2019. Of 386 respondent GPs, 68.9% were familiar with AMS. Respondents most frequently used the Therapeutic Guidelines (TG) (83.2%, 321/385) and delayed antimicrobial prescribing (72.2%, 278/385) strategies, whereas few utilised point-of-care tests (18.4%, 71/382), patient information leaflets (20.2%, 78/384), peer prescribing reports (15.5%, 60/384) and audit and feedback (9.8%, 38/384). GPs were receptive to pharmacists’ recommendations on the choice (50.5%, 192/381) and dose (63%, 241/382) of antimicrobials, and more than 60% (235/381) supported a policy fostering increased GP–pharmacist collaboration. Most GPs agreed to have AMS training (72%, 278/386), integration of electronic TG (eTG) with prescribing software (88.3%, 341/386) and policies limiting the prescribing of selected antimicrobials (74.4%, 287/386) in the future. Conclusively, GPs are aware of the importance of judicious antimicrobial prescribing but inadequately uptake evidence-based AMS strategies. The majority of GPs support GP–pharmacist collaborative AMS approaches to optimise antimicrobial use. Developing a feasible GP–pharmacist collaborative AMS implementation model and facilitating stewardship resources and training could foster AMS activities in primary care.

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“…Keller et al 31 conducted a systematic literature review to explore the extent to which principles from the Systems Engineering Initiative for Patient Safety are applied in studies of ambulatory antibiotic stewardship. This review describes how a work system (ambulatory clinic) contributes to a process (antibiotic prescribing) that leads to outcomes.…”

Section: Applying New Theories and Implementation Science To Transformentioning

confidence: 99%

Advancing the Science of Implementation in Primary Health Care

Bazemore¹,

Neale²,

Lupo³

et al. 2018

J Am Board Fam Med

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Implementation Science is commonly described as the study of methods and approaches that promote the uptake and use of evidence-based interventions into routine practice and policymaking. In this issue of JABFM, investigators share a wealth of new insights from the frontlines of Implementation Science in primary care: what it is, how we are doing it, and how it is advancing the evidence base of primary care. The breadth of implementation science in primary care is affirmed by the range of topics covered, from thought leader recommendations on future directions for the field, to reports on how best practices in policy and practice are shaping primary care implementation in the United States and Canada. There are also important updates on agents of primary care implementation themselves, such as practice facilitators, geriatric care teams, and family physicians interested in providing obstetric care. Other articles report on novel practice transformation efforts that advance health promotion and disease prevention, and innovative approaches to identifying and addressing social determinants of health in primary care practices and the communities they serve. The articles seem to generate as many new questions as they answer, and highlight the need for continued emphasis on advancing the science of implementation in primary health care. (J Am Board Fam Med 2018;31:307-311.)It is commonly estimated that evidence-based interventions require an average of 17 years to be incorporated into routine practice.1,2 Increasing payer and delivery system interest in narrowing that time gap has rapidly elevated the field of Implementation Science; the study of how evidence-based practice and policy can be effectively communicated, deployed, and brought to scale. Effective and efficient implementation is of particular importance in primary care, which is both the largest delivery platform and niche in the US health care ecology and an area largely neglected in the landscape of health care spending and biomedical research. 3,4 This theme issue of JABFM highlights lessons from, and efforts to advance implementation science in primary care.

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Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review

Cited by 34 publications

References 78 publications

Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study

Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study

A Nationwide Survey of Australian General Practitioners on Antimicrobial Stewardship: Awareness, Uptake, Collaboration with Pharmacists and Improvement Strategies

Advancing the Science of Implementation in Primary Health Care

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