Converting habits of antibiotic use for respiratory tract infections in German primary care (CHANGE-3) - process evaluation of a complex intervention

Poß-Doering, Regina; Kühn, Lukas; Kamradt, Martina; Glassen, Katharina; Fleischhauer, Th.; Kaufmann‐Kolle, Petra; Koeppen, Martina; Wollny, Anja; Altiner, Attila; Wensing, Michel

doi:10.1186/s12875-020-01351-2

Cited by 5 publications

(12 citation statements)

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“…Other studies also evaluated the implementation of intervention components similar to our implementation intervention (e.g. online training, champions, outreach visits, leaflets) [43][44][45]. However, unlike in these studies, we distinguished AMS strategies (e.g.…”

Section: Discussionmentioning

confidence: 99%

Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice

Borek

Campbell

Dent

et al. 2021

Implement Sci Commun

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Background Trials show that antimicrobial stewardship (AMS) strategies, including communication skills training, point-of-care C-reactive protein testing (POC-CRPT) and delayed prescriptions, help optimise antibiotic prescribing and use in primary care. However, the use of these strategies in general practice is limited and inconsistent. We aimed to develop an intervention to enhance uptake and implementation of these strategies in primary care. Methods We drew on the Person-Based Approach to develop an implementation intervention in two stages. (1) Planning and design: We defined the problem in behavioural terms drawing on existing literature and conducting primary qualitative research (nine focus groups) in high-prescribing general practices. We identified ‘guiding principles’ with intervention objectives and key features and developed logic models representing intended mechanisms of action. (2) Developing the intervention: We created prototype intervention materials and discussed and refined these with input from 13 health professionals and 14 citizens in two sets of design workshops. We further refined the intervention materials following think-aloud interviews with 22 health professionals. Results Focus groups highlighted uncertainties about how strategies could be used. Health professionals in the workshops suggested having practice champions, brief summaries of each AMS strategy and evidence supporting the AMS strategies, and they and citizens gave examples of helpful communication strategies/phrases. Think-aloud interviews helped clarify and shorten the text and user journey of the intervention materials. The intervention comprised components to support practice-level implementation: antibiotic champions, practice meetings with slides provided, and an ‘implementation support’ website section, and components to support individual-level uptake: website sections on each AMS strategy (with evidence, instructions, links to electronic resources) and material resources (patient leaflets, POC-CRPT equipment, clinician handouts). Conclusions We used a systematic, user-focussed process of developing a behavioural intervention, illustrating how it can be used in an implementation context. This resulted in a multicomponent intervention to facilitate practice-wide implementation of evidence-based strategies which now requires implementing and evaluating. Focusing on supporting the uptake and implementation of evidence-based strategies to optimise antibiotic use in general practice is critical to further support appropriate antibiotic use and mitigate antimicrobial resistance.

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Section: Discussionmentioning

confidence: 99%

Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice

Borek

Campbell

Dent

et al. 2021

Implement Sci Commun

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“…The characteristics of included studies are presented in Table 1 . The studies were conducted across more than 13 countries, with the majority ( n = 17 studies) conducted in United Kingdom ( 25 , 28 , 32 , 37 , 40 , 41 , 43 , 44 , 48–51 , 53 , 63 , 67 , 76 , 77 ), followed by 13 studies from the United States ( 23 , 24 , 35 , 42 , 46 , 47 , 52 , 62 , 65 , 68 , 69 , 71 , 75 ), six studies from the Netherlands ( 33 , 34 , 38 , 39 , 70 , 78 ), three studies each from Canada ( 36 , 54 , 64 ) and Germany ( 72–74 ), two each from Australia ( 29 , 30 ), Spain ( 60 , 61 ), Belgium ( 55 , 56 ), and China ( 79 , 80 ), and single study each from France ( 45 ), Sweden ( 66 ), Russian federation ( 26 ), and Latvia ( 57 ). Five studies recruited participants from multiple countries ( 27 , 31 , 58 , 59 , 81 ).…”

Section: Resultsmentioning

confidence: 99%

“…Various types of interventions were evaluated ( Appendix 4 ). Some were established strategies, such as Treat Antibiotics Responsibly; Guidance, Education (TARGET) ( 28 , 41 , 53 ), antibiotics review kit (ARK) ( 37 ), Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT) ( 60 , 61 ), Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe Internet TRaining for antibiOtic use (GRACE INTRO) ( 27 , 81 ) and Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (CHANGE-3) ( 72 , 74 ), while some were bespoke antimicrobial stewardship programmes ( 23 , 26 , 30 , 34 , 35 , 38 , 42 , 46 , 47 , 49 , 52 , 58 , 59 , 62–66 , 68 , 69 , 77–80 ). C-reactive protein point-of-care testing was often reported ( 26 , 27 , 33 , 34 , 40 , 50 , 51 , 56–59 , 70 , 76 , 81 ).…”

Section: Resultsmentioning

confidence: 99%

Improving healthcare professionals’ interactions with patients to tackle antimicrobial resistance: a systematic review of interventions, barriers, and facilitators

Ayorinde,

Ghosh,

Shaikh

et al. 2024

Front. Public Health

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IntroductionAntimicrobial resistance (AMR) is a major public health threat. With the growing emphasis on patient-centred care/ shared decision making, it is important for healthcare professionals’ (HCPs) who prescribe, dispense, administer and/or monitor antimicrobials to be adequately equipped to facilitate appropriate antimicrobial use. We systematically identified existing interventions which aim to improve HCPs interaction with patients and examined barriers and facilitators of appropriate the use of such interventions and appropriate antimicrobial use among both HCPs and patientsantimicrobial use while using these interventions.MethodsWe searched MEDLINE, EMBASE, Web of Science, Google Scholar, and internet (via Google search engine). We included primary studies, published in English from 2010 to 2023 [PROSPERO (CRD42023395642)]. The protocol was preregistered with PROSPERO (CRD42023395642). We performed quality assessment using mixed methods appraisal tool. We applied narrative synthesis and used the COM-B (Capability, Opportunity, Motivation -Behaviour) as a theoretical framework for barriers and facilitators at HCP and patient levels.ResultsOf 9,172 citations retrieved from database searches, From 4,979 citations remained after removal of duplicates. We included 59 studies spanning over 13 countries. Interventions often involved multiple components beyond HCPs’ interaction with patients. From 24 studies reporting barriers and facilitators, we identified issues relating to capability (such as, knowledge/understanding about AMR, diagnostic uncertainties, awareness of interventions and forgetfulness); opportunity (such as, time constraint and intervention accessibility) and motivation (such as, patient’s desire for antibiotics and fear of litigation).ConclusionThe findings of this review should be considered by intervention designers/adopters and policy makers to improve utilisation and effectiveness.

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“…Hier wird den Patient*innen ein Rezept mitgegeben, welches erst zu einem späteren Zeitpunkt und bei Symptomverschlechterung eingelöst werden soll. Dieses Vorgehen erzeugt eine hohe Akzeptanz bei den betroffenen Patient*innen 23 24 . Diese erwarten letztlich neben der eigentlichen Symptomlinderung vor allem eine positive Rückversicherung durch die behandelnden Ärzt*innen 25 .…”

Section: Diskussionunclassified

Akute Atemwegsinfekte und Antibiotika-Verordnungen: Welche Erwartungen haben Patient*innen?

Wollny

Altiner

Garbe

et al. 2022

Dtsch Med Wochenschr

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Zusammenfassung Einleitung Der Einsatz von Antibiotika in der Humanmedizin ist für den globalen Anstieg der Antibiotika-Resistenzen mitverantwortlich. Aufklärungskampagnen, Kommunikationstrainings und Verordnungsfeedback führten zu einer deutlichen Reduktion der Antibiotika-Verordnungen. Basierend auf Daten der Cluster-randomisierten Studie CHANGE-3 steht in der vorliegenden Analyse die Frage nach der patientenseitigen Erwartungshaltung für ein Antibiotikum bei akuten Atemwegsinfektionen im Mittelpunkt. Methoden An der Untersuchung beteiligten sich 106 von 114 Hausarztpraxen in Baden-Württemberg und Mecklenburg-Vorpommern. 4736 Patient*innen, die von Oktober 2018 bis Mai 2019 mit akuten Atemwegsinfekten in die Praxen kamen, füllten nach der Arztkonsultation einen Fragebogen aus. Die Analyse erfolgte deskriptiv. Ergebnisse 16,7 % der Patient*innen mit akuten Atemwegsinfekten gaben an, Antibiotika von ihren Hausärzt*innen erhalten zu haben. 13,3 % der Patient*innen hatten ein Antibiotikum erhofft und 5,5 % gaben an, die/den Hausärzt*in darum gebeten zu haben. Der geringste Anteil an Antibiotika-Verordnungen entfiel auf Patient*innen, die die Diagnose eines grippalen Infekts vom/von der Ärzt*in kommuniziert bekamen. Mit spezifischen Diagnosen in Abgrenzung zum unkomplizierten Atemwegsinfekt wurde ein Anstieg sowohl der Anzahl der erhofften als auch der verordneten Antibiotika beobachtet. Diskussion Patient*innen erhalten nach wie vor häufiger Antibiotika, als es von ihnen erhofft wird. Auf Seiten der Hausärzt*innen könnten die Verordnungen nach wie vor aufgrund eines gefühlten Drucks durch die Patient*innen stattfinden, die sich jedoch so nicht in der Erwartungshaltung der Patient*innen widerspiegelt. Neben einer offenen Exploration der Erwartungshaltung der Patient*innen könnten die Stärkung ihrer Gesundheitskompetenz, eine achtsame Arzt-Patienten-Kommunikation und angebotene Wiedervorstellungsmöglichkeiten bei spezifischen Diagnosen den gefühlten Druck auf Seiten der Ärzt*innen weiter reduzieren.

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Converting habits of antibiotic use for respiratory tract infections in German primary care (CHANGE-3) - process evaluation of a complex intervention

Cited by 5 publications

References 36 publications

Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice

Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice

Improving healthcare professionals’ interactions with patients to tackle antimicrobial resistance: a systematic review of interventions, barriers, and facilitators

Akute Atemwegsinfekte und Antibiotika-Verordnungen: Welche Erwartungen haben Patient*innen?

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