Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee DD2 4BF, Scotland, UK.
Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee DD2 4BF, Scotland, UK.
Int J Antimicrob Agents. 2015 Mar;45(3):203-12. doi: 10.1016/j.ijantimicag.2014.11.014. Epub 2015 Jan 7.
There is strong evidence that self-monitoring and feedback are effective behaviour change techniques (BCTs) across a range of healthcare interventions and that their effectiveness is enhanced by goal setting and action planning. Here we report a summary of the update of a systematic review assessing the application of these BCTs to improving hospital antibiotic prescribing. This paper includes studies with valid prescribing outcomes published before the end of December 2012. We used a structured method for reporting these BCTs in terms of specific characteristics and contacted study authors to request additional intervention information. We identified 116 studies reporting 123 interventions. Reporting of BCTs was poor, with little detail of BCT characteristics. Feedback was only reported for 17 (13.8%) of the interventions, and self-monitoring was used in only 1 intervention. Goals were reported for all interventions but were poorly specified, with only three of the nine characteristics reported for ≥50% of interventions. A goal threshold and timescale were specified for just 1 of the 123 interventions. Only 29 authors (25.0%) responded to the request for additional information. In conclusion, both the content and reporting of interventions for antimicrobial stewardship fell short of scientific principles and practices. There is a strong evidence base regarding BCTs in other contexts that should be applied to antimicrobial stewardship now if we are to further our understanding of what works, for whom, why and in what contexts.
有强有力的证据表明，自我监测和反馈是一系列医疗干预措施中有效的行为改变技术（BCT），通过设定目标和行动计划可以增强其有效性。在这里，我们报告了一项系统评价更新的总结，该评价评估了这些 BCT 在改善医院抗生素处方方面的应用。本文包括在 2012 年 12 月底之前发表的具有有效处方结果的研究。我们使用一种结构化的方法，根据特定特征报告这些 BCT，并联系研究作者以请求额外的干预信息。我们确定了 116 项报告 123 项干预措施的研究。BCT 的报告情况不佳，缺乏 BCT 特征的详细信息。仅对 17 项（13.8%）干预措施报告了反馈，仅在 1 项干预措施中使用了自我监测。所有干预措施都报告了目标，但目标规定得很差，只有 9 项特征中的 3 项报告了≥50%的干预措施。仅对 123 项干预措施中的 1 项规定了目标阈值和时间范围。只有 29 位作者（25.0%）对额外信息的请求做出了回应。总之，抗菌药物管理干预措施的内容和报告都不符合科学原则和实践。在其他背景下，BCT 有很强的证据基础，如果我们要进一步了解什么有效、为什么有效、对谁有效以及在什么情况下有效，那么现在就应该将这些证据应用于抗菌药物管理。
