Department of Design and Environmental Analysis, Cornell University, Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA.
Department of Communication, Cornell University, 476 Mann Library Building, Ithaca, NY, 14853, USA.
J Med Syst. 2020 Feb 10;44(3):64. doi: 10.1007/s10916-020-1531-y.
A rise in antimicrobial resistance, seen especially since 2000, is in part caused by indiscriminate antimicrobial use. Varied types of persuasive interventions aimed to optimize antimicrobial use have been tried with varying success. Our review seeks to identify and assess factors associated with the successful implementation of persuasive interventions. We searched five databases (MEDLINE, EMBASE, The Cochrane Library, PsycINFO, and ERIC) to identify critical studies published between 2000 and December 2018 of interventions employing audit and feedback, education through meetings, academic detailing, reminders, and patient, family, or public education. Outcome measures of interest were any means to measure antimicrobial use. We included 26 articles in our analysis. Seventeen examined multimodal interventions and the most common was audit and feedback and meeting (four studies). Nine examined single interventions and the most common was audit and feedback (five studies). Our findings inform four evidence-based strategies to enable healthcare administrators, clinicians, and researchers to make informed choices when planning and designing an antimicrobial stewardship program: (1) implement a combination of persuasive interventions from both groups: audit and feedback, academic detailing, or patient, family, or provider education; and meeting or reminders, (2) design interventions that last one year or longer; post-intervention, assess the intervention's long-term effects for at least another one year, (3) conduct quality improvement projects examining persuasive interventions if the prescribing database provides adequate diagnosis information, and most importantly, (4) make patient, family, or provider education an integral component of multimodal intervention.
抗微生物药物耐药性的上升，尤其是自 2000 年以来的上升，部分是由于抗微生物药物的不合理使用。已经尝试了各种旨在优化抗微生物药物使用的有说服力的干预措施，但取得的成功程度不一。我们的综述旨在确定和评估与成功实施有说服力的干预措施相关的因素。我们在五个数据库（MEDLINE、EMBASE、The Cochrane Library、PsycINFO 和 ERIC）中搜索了 2000 年至 2018 年 12 月期间发表的关键研究，这些研究采用了审核和反馈、会议教育、学术细化、提醒以及患者、家庭或公众教育等干预措施。感兴趣的结果衡量标准是衡量抗微生物药物使用的任何手段。我们的分析包括 26 篇文章。其中 17 项研究了多模式干预措施，最常见的是审核和反馈以及会议（四项研究）。有 9 项研究了单一干预措施，最常见的是审核和反馈（五项研究）。我们的发现为医疗保健管理人员、临床医生和研究人员提供了四项基于证据的策略，以便在规划和设计抗微生物药物管理计划时做出明智的选择：（1）实施来自两组的组合有说服力的干预措施：审核和反馈、学术细化或患者、家庭或提供者教育；以及会议或提醒，（2）设计持续一年或更长时间的干预措施；在干预后，至少再评估干预措施的长期效果一年，（3）如果处方数据库提供足够的诊断信息，开展质量改进项目，以检查有说服力的干预措施，最重要的是，（4）使患者、家庭或提供者教育成为多模式干预措施的一个组成部分。
