Financial strategies targeting healthcare providers to promote the prudent use of antibiotics: a systematic review of the evidence

Yoshikawa, Yuki; Feldhaus, Isabelle; Özçelik, Ece; Hashiguchi, Tiago Cravo Oliveira; Cecchini, Michele

doi:10.1016/j.ijantimicag.2021.106446

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…Re-evaluation is needed by many stakeholders including physicians, patients, payers, and policymakers to safeguard the effectiveness of antibiotics ( 86 ). Antibiotic stewardship can most efficiently be achieved by acting on several fronts and deploying several complementary strategies in parallel ( 87 ).…”

Section: Recommendationsmentioning

confidence: 99%

C-reactive protein point-of-care testing in primary care—broader implementation needed to combat antimicrobial resistance

Llor,

Plate,

Bjerrum

et al. 2024

Front. Public Health

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This study presents the perspective of an international group of experts, providing an overview of existing models and policies and guidance to facilitate a proper and sustainable implementation of C-reactive protein point-of-care testing (CRP POCT) to support antibiotic prescribing decisions for respiratory tract infections (RTIs) with the aim to tackle antimicrobial resistance (AMR). AMR threatens to render life-saving antibiotics ineffective and is already costing millions of lives and billions of Euros worldwide. AMR is strongly correlated with the volume of antibiotics used. Most antibiotics are prescribed in primary care, mostly for RTIs, and are often unnecessary. CRP POCT is an available tool and has been proven to safely and cost-effectively reduce antibiotic prescribing for RTIs in primary care. Though established in a few European countries during several years, it has still not been implemented in many European countries. Due to the complexity of inappropriate antibiotic prescribing behavior, a multifaceted approach is necessary to enable sustainable change. The effect is maximized with clear guidance, advanced communication training for primary care physicians, and delayed antibiotic prescribing strategies. CRP POCT should be included in professional guidelines and implemented together with complementary strategies. Adequate reimbursement needs to be provided, and high-quality, and primary care-friendly POCT organization and performance must be enabled. Data gathering, sharing, and discussion as incentivization for proper behaviors should be enabled. Public awareness should be increased, and healthcare professionals’ awareness and understanding should be ensured. Impactful use is achieved when all stakeholders join forces to facilitate proper implementation.

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Section: Recommendationsmentioning

confidence: 99%

C-reactive protein point-of-care testing in primary care—broader implementation needed to combat antimicrobial resistance

Llor,

Plate,

Bjerrum

et al. 2024

Front. Public Health

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“…Numerous government policy interventions aim to reduce antibiotic prescribing and AMR [64], e.g., in Taiwan by means of prohibition [65] or in Sweden, where pay-for-performance measures have shown to have a positive impact, with a sustained and long-term increase in narrow spectrum antibiotic prescribing [66]. However, financial penalties seem to have the largest effect in decreasing antibiotic prescriptions, followed by bonus systems [67]. Strategies that combine financial penalties with rewarding measures, potentially integrated through gamification, hold promise in enhancing guideline adherence [68].…”

Section: Potential Barriers To Implementationmentioning

confidence: 99%

GPs’ Perspective on a Multimodal Intervention to Enhance Guideline-Adherence in Uncomplicated Urinary Tract Infections: A Qualitative Process Evaluation of the Multicentric RedAres Cluster-Randomised Controlled Trial

Schuster,

Tigges,

Grune

et al. 2023

Antibiotics

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Urinary tract infections (UTIs) are among the most common reasons patients seeking health care and antibiotics to be prescribed in primary care. However, general practitioners’ (GPs) guideline adherence is low. The RedAres randomised controlled trial aims to increase guideline adherence by implementing a multimodal intervention consisting of four elements: information on current UTI guidelines (1) and regional resistance data (2); feedback regarding prescribing behaviour (3); and benchmarking compared to peers (4). The RedAres process evaluation assesses GPs’ perception of the multimodal intervention and the potential for implementation into routine care. We carried out 19 semi-structured interviews with GPs (intervention arm). All interviews were carried out online and audio recorded. For transcription and analysis, Mayring’s qualitative content analysis was used. Overall, GPs considered the interventions helpful for knowledge gain and confirmation when prescribing. Information material and resistance were used for patient communication and teaching purposes. Feedback was considered to enhance reflection by breaking routines of clinical workup. Implementation into routine practice could be enhanced by integrating feedback loops into patient management systems and conveying targeted information via trusted channels or institutions. The process evaluation of RedAres intervention was considered beneficial by GPs. It confirms the convenience of multimodal interventions to enhance guideline adherence.

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“…Additionally, several recent reviews have evaluated the effectiveness of a single type of population-level intervention. For example, financial strategies targeting healthcare providers are associated with improvement in appropriate antibiotic use [ 13 ]; communication interventions, such as public awareness campaign and public health interventions using social media, have limited impact on improving consumers’ knowledge and changing their behaviors [ 14 ]. To date, no existing review has provided a comprehensive assessment of the effectiveness of population-level interventions.…”

Section: Introductionmentioning

confidence: 99%

Evaluating population-level interventions to reduce inappropriate antibiotic use in healthcare and community settings: A systematic review protocol

Wu,

Magwood,

Dong

et al. 2024

PLoS ONE

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Background Inappropriate antibiotic use contributes significantly to the global challenge of antimicrobial resistance. While government-initiated population-level interventions are fundamental in addressing this issue, their full potential remains to be explored. This systematic review aims to assess the effectiveness of such interventions in reducing inappropriate antibiotic use among antibiotic providers and users in healthcare and community settings. Methods We will conduct a systematic literature search across multiple databases and grey literature sources. We will include studies which evaluate the effectiveness of population-level interventions to reduce inappropriate antibiotic use in healthcare and community settings in both high-income and low- and middle-income countries. This includes government-initiated measures targeting antibiotic use through education, restriction, incentivization, coercion, training, persuasion, context modification, behavior modeling, or barrier reduction. Two reviewers will independently perform screening to select eligible studies, followed by data extraction. The outcomes of interest are various measures of antibiotic prescription and consumption, such as Defined Daily Dose (DDD) or number of prescriptions per year. We anticipate including a broad range of study designs and outcome measures. Therefore, we will narratively synthesize results using the categories of the population-level policy interventions of the Behavior Change Wheel Framework. We will organize outcome data by economic contexts, target populations, and implementation settings. Discussion This review will strengthen the evidence base for the use of population-level interventions to address inappropriate antibiotic use. Drawing lessons from global experiences, the findings will provide valuable guidance to health policymakers, public health authorities, and researchers on tailoring interventions to specific economic contexts, populations, and settings, thereby enhancing their capacity to drive substantial improvement in appropriate antibiotic use.

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Financial strategies targeting healthcare providers to promote the prudent use of antibiotics: a systematic review of the evidence

Cited by 8 publications

References 28 publications

C-reactive protein point-of-care testing in primary care—broader implementation needed to combat antimicrobial resistance

C-reactive protein point-of-care testing in primary care—broader implementation needed to combat antimicrobial resistance

GPs’ Perspective on a Multimodal Intervention to Enhance Guideline-Adherence in Uncomplicated Urinary Tract Infections: A Qualitative Process Evaluation of the Multicentric RedAres Cluster-Randomised Controlled Trial

Evaluating population-level interventions to reduce inappropriate antibiotic use in healthcare and community settings: A systematic review protocol

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