VA Tennessee Valley Healthcare System, 1310 24th ave S 37212, USA.
Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1475, 37203, USA.
Transl Behav Med. 2023 Dec 15;13(12):928-943. doi: 10.1093/tbm/ibad063.
Successfully changing prescribing behavior to reduce inappropriate antibiotic and nonsteroidal anti-inflammatory drug (NSAID) prescriptions often requires combining components into a multicomponent intervention. However, multicomponent interventions often fail because of development and implementation complexity. To increase the likelihood of successfully changing prescribing behavior, we applied a systematic process to design and implement a multicomponent intervention. We used Intervention Mapping to create a roadmap for a multicomponent intervention in unscheduled outpatient care settings in the Veterans Health Administration. Intervention Mapping is a systematic process consisting of six steps that we grouped into three phases: (i) understand behavioral determinants and barriers to implementation, (ii) develop the intervention, and (iii) define evaluation plan and implementation strategies. A targeted literature review, combined with 25 prescriber and 25 stakeholder interviews, helped identify key behavioral determinants to inappropriate prescribing (e.g. perceived social pressure from patients to prescribe). We targeted three desired prescriber behaviors: (i) review guideline-concordant prescribing and patient outcomes, (ii) manage diagnostic and treatment uncertainty, and (iii) educate patients and caregivers. The intervention consisted of components for academic detailing, prescribing feedback, and alternative prescription order sets. Implementation strategies consisted of preparing clinical champions, conducting readiness assessments, and incentivizing use of the intervention. We chose a mixed-method study design with a commonly used evaluation framework to assess effectiveness and implementation outcomes in a subsequent trial. This study furthers knowledge about causes of inappropriate antibiotic and NSAID prescribing and demonstrates how theoretical, empirical, and practical information can be systematically applied to develop a multicomponent intervention to help address these causes.
成功改变处方行为以减少不合理的抗生素和非甾体抗炎药（NSAID）处方，通常需要将各个组成部分整合到一个多组分干预措施中。然而，多组分干预措施常常因为开发和实施的复杂性而失败。为了提高成功改变处方行为的可能性，我们应用了一个系统的过程来设计和实施多组分干预措施。我们使用干预映射法为退伍军人健康管理局的非计划性门诊护理环境制定了一个多组分干预措施的路线图。干预映射法是一个系统的过程，由六个步骤组成，我们将其分为三个阶段：（i）了解行为决定因素和实施障碍，（ii）开发干预措施，以及（iii）定义评估计划和实施策略。有针对性的文献综述，结合 25 名医生和 25 名利益相关者的访谈，有助于确定不合理处方的关键行为决定因素（例如，医生感受到来自患者的开具处方的社会压力）。我们将三个预期的医生行为作为目标：（i）审查符合指南的处方和患者结局，（ii）管理诊断和治疗的不确定性，以及（iii）教育患者和护理人员。干预措施包括学术细节、处方反馈和替代处方医嘱集。实施策略包括准备临床拥护者、进行准备情况评估和激励使用干预措施。我们选择了一种混合方法研究设计，并使用常用的评估框架，以在随后的试验中评估有效性和实施结果。这项研究进一步了解了不合理抗生素和 NSAID 处方的原因，并展示了如何系统地应用理论、经验和实践信息来开发一个多组分干预措施，以帮助解决这些原因。
