Ashiru-Oredope D, Budd E L, Bhattacharya A, Din N, McNulty C A M, Micallef C, Ladenheim D, Beech E, Murdan S, Hopkins S
Antimicrobial Resistance Programme, Public Health England, London, UK
Antimicrobial Resistance Programme, Public Health England, London, UK.
J Antimicrob Chemother. 2016 May;71(5):1408-14. doi: 10.1093/jac/dkv492. Epub 2016 Feb 10.
To assess and compare the implementation of antimicrobial stewardship (AMS) interventions recommended within the national AMS toolkits, TARGET and Start Smart Then Focus, in English primary and secondary healthcare settings in 2014, to determine the prevalence of cross-sector engagement to drive AMS interventions and to propose next steps to improve implementation of AMS.
Electronic surveys were circulated to all 211 clinical commissioning groups (CCGs; primary sector) and to 146 (out of the 159) acute trusts (secondary sector) in England. Response rates were 39% and 63% for the primary and secondary sectors, respectively.
The majority of CCGs and acute trusts reported reviewing national AMS toolkits formally or informally (60% and 87%, respectively). However, only 13% of CCGs and 46% of acute trusts had developed an action plan for the implementation of these toolkits. Only 5% of CCGs had antimicrobial pharmacists in post; however, the role of specialist antimicrobial pharmacists continued to remain embedded within acute trusts, with 83% of responding trusts having an antimicrobial pharmacist at a senior grade.
The majority of healthcare organizations review national AMS toolkits; however, implementation of the toolkits, through the development of action plans to deliver AMS interventions, requires improvement. For the first time, we report the extent of cross-sector and multidisciplinary collaboration to deliver AMS interventions in both primary and secondary care sectors in England. Results highlight that further qualitative and quantitative work is required to explore mutual benefits and promote best practice. Antimicrobial pharmacists remain leaders for implementing AMS interventions across both primary and secondary healthcare sectors.
评估并比较2014年在英国初级和二级医疗保健机构中，国家抗菌药物管理（AMS）工具包“目标（TARGET）”和“先明智起步再重点关注（Start Smart Then Focus）”所推荐的AMS干预措施的实施情况，确定跨部门参与推动AMS干预措施的普遍性，并提出改善AMS实施的后续步骤。
向英格兰所有211个临床委托小组（CCG，初级医疗部门）以及146个（共159个）急性病信托机构（二级医疗部门）进行电子问卷调查。初级和二级医疗部门的回复率分别为39%和63%。
大多数CCG和急性病信托机构报告称已正式或非正式地查阅了国家AMS工具包（分别为60%和87%）。然而，只有13%的CCG和46%的急性病信托机构制定了实施这些工具包的行动计划。只有5%的CCG设有抗菌药物药师岗位；不过，专科抗菌药物药师的角色在急性病信托机构中仍持续存在，83%的回复信托机构设有高级抗菌药物药师。
大多数医疗保健机构查阅了国家AMS工具包；然而，通过制定实施AMS干预措施的行动计划来实施这些工具包仍需改进。我们首次报告了在英格兰初级和二级医疗保健部门中为实施AMS干预措施而进行的跨部门和多学科协作的程度。结果表明，需要进一步开展定性和定量工作，以探索互利之处并推广最佳实践。抗菌药物药师仍是在初级和二级医疗保健部门实施AMS干预措施的主导力量。
