Study reporting quality among interventions to reduce antibiotic use is a barrier to evidence-informed policymaking on antimicrobial resistance: systematic review

Abstract

Background Countries are currently seeking evidence-informed policy options to address antimicrobial resistance (AMR). While rigorous evaluations of AMR interventions are the ideal, they are far from the current reality. Additionally, poor reporting and documentation of AMR interventions impede efforts to use evidence to inform future evaluations and policy interventions. Objectives To critically evaluate reporting quality gaps in AMR intervention research. Methods To evaluate the reporting quality of studies, we conducted a descriptive synthesis and comparative analysis of studies that were included in a recent systematic review of government policy interventions aiming to reduce human antimicrobial use. Reporting quality was assessed using the SQUIRE 2.0 checklist of 18 items for reporting system-level interventions to improve healthcare. Two reviewers independently applied the checklist to 66 studies identified in the systematic review. Results None of the studies included complete information on all 18 SQUIRE items (median score = 10, IQR = 8–11). Reporting quality varied across SQUIRE items, with 3% to 100% of studies reporting the recommended information for each SQUIRE item. Only 20% of studies reported the elements of the intervention in sufficient detail for replication and only 24% reported the mechanism through which the intervention was expected to work. Conclusions Gaps in the reporting of impact evaluations pose challenges for interpreting and replicating study results. Failure to improve reporting practice of policy evaluations is likely to impede efforts to tackle the growing health, social and economic threats posed by AMR.

Strengthening the science of addressing antimicrobial resistance: a framework for planning, conducting and disseminating antimicrobial resistance intervention research

“…Among these 69 studies, only 4 used a randomised controlled design which is considered the gold standard for evaluating interventions. Another systematic review of 221 interventions for improving antibiotic prescribing among hospital inpatients found the quality of the reporting for the 163 non-randomised studies was so poor that it was difficult for professionals to use the research findings or to implement interventions that were shown to be useful; further, this systematic review found that no useful evidence could be gleaned from studies using controlled before-after and non-randomised trial designs [17] Reporting of AMR policy intervention studies is weak; studies often fail to describe the intervention in sufficient detail for replication and many do not report the reason the intervention is expected to work [21] In the broader field of public health, researchers have estimated that at least 50% of published research is not sufficiently clear, complete or accurate for others to interpret or use [23,24] There are no standardised measures and metrics for AMR research; many AMR intervention studies report antimicrobial use in defined daily dose per 1000 population or a simple prescribing rate [21] practices for overcoming common limitations in evaluating AMR policies. Some of these challenges are specific to AMR, while others are shared with other areas of health research.…”

“…The goal of this paper is to develop a framework that facilitates the strengthening of this evidence base. This paper is not intended as a formal research prioritisation process but, rather, builds upon the findings from recent systematic reviews of interventions to reduce antimicrobial consumption [6,17,21,25] and efforts by others to strengthen research on AMR and public health [17,23,[26][27][28][29][30], and aims to draw insights for improving the planning, conduct and dissemination of research to evaluate AMR policy interventions (Fig. 1).…”

“…The framework identifies challenges in AMR evaluation research, areas for enhanced coordination and cooperation with policy-makers, and best-Fig. 1 Framework for prioritising, conducting and disseminating AMR policy interventions Box 1 Current state of the evidence base on AMR policy interventions Around the world, 129 governments are currently in the process of developing or implementing a National Action Plan to address antimicrobial resistance [19] Global capacity for AMR surveillance is lacking; discrepancies between methods and monitoring systems, data quality concerns and lack of representativeness make it challenging to compare AMR data between countries [20] Many evaluations of AMR policy interventions are conducted retrospectively by academics who were not involved in the design or implementation of the intervention [6,21] A systematic review of experimental and quasi-experimental studies evaluating government policy interventions to reduce the use of antimicrobials [6,22] found that 30 of the 69 studies used low-quality study designs, such as uncontrolled before-after designs, which severely limits the validity of their findings. Among these 69 studies, only 4 used a randomised controlled design which is considered the gold standard for evaluating interventions.…”

Evidence for action: a One Health learning platform on interventions to tackle antimicrobial resistance

“… 36 , 37 , 38 , 39 In particular, evaluating the complexity of interventions and the quality of reporting would be beneficial to move the science of interventions for antimicrobial resistance forward. 40 , 41 …”

“…[36][37][38][39] In particular, evaluating the complexity of interventions and the quality of reporting would be beneficial to move the science of interventions for antimicrobial resistance forward. 40,41 An open access learning platform on interventions for antimicrobial resistance might be useful to a broad range of stakeholders, including health-care professionals, public health practitioners, policy makers, industries, and consumer groups. 42 The capacities to fully search the database and to export data in a convenient format are essential to make the platform a valuable tool for those involved in addressing antimicrobial resistance.…”