Beyond implementation: Uncovering the parallels between de-implementation and antimicrobial stewardship

Abstract

De-implementation is defined as the process of discontinuing, removing, reducing, or replacing a harmful, ineffective, or low-value clinical practice or intervention. The goal of de-implementation strategies is to minimize patient harm, maximize use of resources, and reduce healthcare costs and inequities. Both antibiotic and diagnostic stewardship programs focus on reducing low-value interventions (tests or antimicrobials). Stewardship interventions commonly involve de-implementation and deprescribing strategies. This commentary explores unique aspects of deimplementing low-value testing and unnecessary antimicrobial use, similarities between de-implementation and stewardship approaches, multilevel factors that impact de-implementation, and opportunities for future research.

Barriers and facilitators to guideline concordant dental antibiotic prescribing in the United States: A qualitative study of the National Dental PBRN

“…Future work should focus on de-implementation strategies to reduce unnecessary antibiotic prescribing. De-implementation is defined as the process of removing, reducing, or discontinuing a clinical practice and intervention and have similarities to antibiotic stewardship strategies such as shortening duration of antibiotics, formulary restriction, and stopping antibiotics, respectively (43). Some strategies utilized in de-implementation of prescribing behaviors have included: prescribing reminders, educational materials, audit and feedback, monitoring performance, practice guidelines, interprofessional education, financial incentives, and payfor-performance (44).…”