Implementation of a Delayed Prescribing Model to Reduce Antibiotic Prescribing for Suspected Upper Respiratory Tract Infections in a Hospital Outpatient Department, Ghana

Ghebrehewet, Sam; Shepherd, Wendi; Panford-Quainoo, Edwin; Shantikumar, Saran; Decraene, Valérie; Rajendran, Rajesh; Kaushal, Menaal; Akuffo, Afua; Ayerh, Dinah; Amofah, George

doi:10.3390/antibiotics9110773

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…Eight studies reported patient needs and resources as a barrier to changing prescribing practice, as participants were often pressured by patients to prescribe antibiotics, despite the ongoing interventions [ 39 , 48 , 49 , 51 , 60 , 62 , 65 , 66 ]. External policy and incentives were addressed in a total of 22 studies.…”

Section: Resultsmentioning

confidence: 99%

“…Leadership engagement refers to the degree to which leaders are committed to, involved in, and held accountable for the implementation of interventions. In 21 studies, the involvement and support of higher-level stakeholders (such as officials from the Ministry of Health, health authorities, experts, leaders in health facilities) and administrative staff were reported as a common facilitator for the successful implementation of behavior change interventions [ 37 , 39 , 40 , 44 , 48 – 50 , 52 , 54 , 56 , 58 , 59 , 62 , 65 , 70 , 78 – 83 ]. The lack thereof had been documented to impede intervention implementation in seven studies [ 43 , 46 , 60 , 63 , 69 , 71 , 84 ].…”

Section: Resultsmentioning

confidence: 99%

“…Access to knowledge and information about interventions was recognized as a facilitator in nine studies [ 41 , 43 , 51 , 53 , 55 , 61 , 65 , 80 , 83 ]. Implementers and researchers employed training, education sessions, and other publicity strategies to help participants access intervention information and familiarize with intervention activities and content.…”

Section: Resultsmentioning

confidence: 99%

“…The engagement with stakeholders, as well as between intervention participants, was usually facilitated by good communication (networks and communications) [ 37 , 43 , 47 , 50 , 81 ]. Additionally, studies reported that patients sometimes pressured physicians to prescribe antibiotics (patients’ needs and resources), which might contribute to low motivation for changing prescribing behavior among prescribers (other personal attributes) [ 60 , 62 , 65 , 81 ].

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Section: Resultsmentioning

confidence: 99%

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Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research

Tannous

Haldane

et al. 2022

Implementation Sci

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Background Behavior change interventions that aim to improve rational antibiotic use in prescribers and users have been widely conducted in both high- and LMICs. However, currently, no review has systematically examined challenges unique to LMICs and offered insights into the underlying contextual factors that influence these interventions. We adopted an implementation research perspective to systematically synthesize the implementation barriers and facilitators in LMICs. Methods We conducted literature searches in five electronic databases and identified studies that involved the implementation of behavior change interventions to improve appropriate antibiotic use in prescribers and users in LMICs and reported implementation barriers and facilitators. Behavior change interventions were defined using the behavior change wheel, and the coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research (CFIR). Results We identified 52 eligible studies, with the majority targeting prescribers practicing at tertiary facilities (N=39, 75%). The most commonly reported factors influencing implementation were found in the inner setting domain of the CFIR framework, particularly related to constraints in resources and the infrastructure of the facilities where interventions were implemented. Barriers related to the external policy environment (e.g., lack of national initiatives and policies on antibiotic use), and individual characteristics of target populations (e.g., reluctance to change prescribing behaviors) were also common, as well as facilitators related to intervention characteristics (e.g., embedding interventions in routine practice) and process (e.g., stakeholder engagement). We also provided insights into the interrelationships between these factors and the underlying causes contributing to the implementation challenges in LMICs. Conclusion We presented a comprehensive overview of the barriers and facilitators of implementing behavior change interventions to promote rational antibiotic use in LMICs. Our findings suggest that facilitating the implementation of interventions to improve rational antibiotic use needs comprehensive efforts to address challenges at policy, organizational, and implementation levels. Specific strategies include (1) strengthening political commitment to prompt mobilization of domestic resources and formulation of a sustainable national strategy on AMR, (2) improving the infrastructure of health facilities that allow prescribers to make evidence-based clinical decisions, and (3) engaging local stakeholders to improve their buy-in and facilitate contextualizing interventions. Trial registration PROSPERO: CRD42021252715.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Fig.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research

Tannous

Haldane

et al. 2022

Implementation Sci

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“…The results on the use of the checklist post-CwPAMS programme, including a range of interventions [ 9 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], indicate that the greatest improvements were observed in the core elements relating to senior AMS leadership, accountability, and responsibility. Smaller improvements were reported with regard to the availability of AMS expertise, education and practical training, monitoring and surveillance, and other AMS actions.…”

Section: Discussionmentioning

confidence: 99%

Development and Implementation of an Antimicrobial Stewardship Checklist in Sub-Saharan Africa: A Co-Creation Consensus Approach

Ashiru‐Oredope¹,

Garraghan

Olaoye³

et al. 2022

Healthcare

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Antimicrobial stewardship (AMS) initiatives promote the responsible use of antimicrobials in healthcare settings as a key measure to curb the global threat of antimicrobial resistance (AMR). Defining the core elements of AMS is essential for developing and evaluating comprehensive AMS programmes. This project used co-creation and Delphi consensus procedures to adapt and extend the existing published international AMS checklist. The overall objective was to arrive at a contextualised checklist of core AMS elements and key behaviours for use within healthcare settings in Sub-Saharan Africa, as well as to implement the checklist in health institutions in four African countries. The AMS checklist tool was developed using a modified Delphi approach to achieve local expert consensus on the items to be included on the checklist. Fourteen healthcare/public health professionals from Tanzania, Zambia, Uganda, Ghana and the UK were invited to review, score and comment on items from a published global AMS checklist. Following their feedback, 8 items were rephrased, and 25 new items were added to the checklist. The final AMS checklist tool was deployed across 19 healthcare sites and used to assess AMS programmes before and after an AMS intervention in 14 of the 19 sites. The final tool comprised 54 items. Across the 14 sites, the completed checklists consistently showed improvements for all the AMS components following the intervention. The greatest improvements observed were the presence of formal multidisciplinary AMS structures (79%) and the execution of a point-prevalence survey (72%). The elements with the least improvement were access to laboratory/imaging services (7%) and the presence of adequate financial support for AMS (14%). In addition to capturing the quantitative and qualitative changes associated with the AMS intervention, project evaluation suggested that administering the AMS checklist made unique contributions to ongoing AMS activities. Furthermore, 29 additional AMS activities were reported as a direct result of the prompting checklist questions. Contextualised, co-created AMS tools are necessary for managing antimicrobial use across healthcare settings and increasing local AMS ownership and commitment. This study led to the development of a new AMS checklist, which proved successful in capturing AMS improvements in Tanzania, Zambia, Uganda, and Ghana. The tool also made unique contributions to furthering local AMS efforts. This study extends the existing AMS materials for low- and middle-income countries and provides empirical evidence for successful use in practice.

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Delayed antibiotic prescriptions for respiratory infections

Spurling

Mar

Dooley

et al. 2017

Cochrane Database of Systematic Reviews

166

192

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For many clinical outcomes, there were no differences between prescribing strategies. Symptoms for acute otitis media and sore throat were modestly improved by immediate antibiotics compared with delayed antibiotics. There were no differences in complication rates. Delaying prescribing did not result in significantly different levels of patient satisfaction compared with immediate provision of antibiotics (86% versus 91%) (moderate quality evidence). However, delay was favoured over no antibiotics (87% versus 82%). Delayed antibiotics achieved lower rates of antibiotic use compared to immediate antibiotics (31% versus 93%) (moderate quality evidence). The strategy of no antibiotics further reduced antibiotic use compared to delaying prescription for antibiotics (14% versus 28%). Delayed antibiotics for people with acute respiratory infection reduced antibiotic use compared to immediate antibiotics, but was not shown to be different to no antibiotics in terms of symptom control and disease complications. Where clinicians feel it is safe not to prescribe antibiotics immediately for people with respiratory infections, no antibiotics with advice to return if symptoms do not resolve is likely to result in the least antibiotic use while maintaining similar patient satisfaction and clinical outcomes to delaying prescription of antibiotics. Where clinicians are not confident in using a no antibiotic strategy, a delayed antibiotics strategy may be an acceptable compromise in place of immediate prescribing to significantly reduce unnecessary antibiotic use for RTIs, and thereby reduce antibiotic resistance, while maintaining patient safety and satisfaction levels.Editorial note: As a living systematic review, this review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

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Implementation of a Delayed Prescribing Model to Reduce Antibiotic Prescribing for Suspected Upper Respiratory Tract Infections in a Hospital Outpatient Department, Ghana

Cited by 6 publications

References 14 publications

Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research

Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research

Development and Implementation of an Antimicrobial Stewardship Checklist in Sub-Saharan Africa: A Co-Creation Consensus Approach

Delayed antibiotic prescriptions for respiratory infections

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