Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
J Antimicrob Chemother. 2024 Jun 3;79(6):1234-1247. doi: 10.1093/jac/dkae061.
To identify and assess the effectiveness of national antibiotic optimization interventions in primary and secondary care in England (2013-2022).
A systematic scoping review was conducted. Literature databases (Embase and Medline) were used to identify interventions and evaluations. Reports included the UK AMR Strategy (2013-2018), National Action Plan (2019-2024) and English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) reports (2014-2022). The design, focus and quality of evaluations and the interventions' effectiveness were extracted.
Four hundred and seventy-seven peer-reviewed studies and 13 reports were screened. One hundred and three studies were included for review, identifying 109 interventions in eight categories: policy and commissioning (n = 9); classifications (n = 1); guidance and toolkits (n = 22); monitoring and feedback (n = 17); professional engagement and training (n = 19); prescriber tools (n = 12); public awareness (n = 17); workforce and governance (n = 12).Most interventions lack high-quality effectiveness evidence. Evaluations mainly focused on clinical, microbiological or antibiotic use outcomes, or intervention implementation, often assessing how interventions were perceived to affect behaviour. Only 16 interventions had studies that quantified effects on prescribing, of which six reported reductions. The largest reduction was reported with structural-level interventions and attributed to a policy and commissioning intervention (primary care financial incentives). Behavioural interventions (guidance and toolkits) reported the greatest impact in hospitals.
Many interventions have targeted antibiotic use, each pulling different levers across the health system simultaneously. On the basis of these studies, structural-level interventions may have the greatest impact. Collectively, the combination of interventions may explain England's decline in prescribing but direct evidence of causality is unavailable.
识别和评估 2013 年至 2022 年期间英格兰初级和二级保健中全国抗生素优化干预的效果。
进行了系统的范围界定审查。文献数据库（Embase 和 Medline）用于确定干预措施和评估报告。报告包括英国抗菌素耐药性战略（2013-2018 年）、国家行动计划（2019-2024 年）和英国抗菌素使用和耐药性监测计划（ESPAUR）报告（2014-2022 年）。提取了评估报告的设计、重点和质量以及干预措施的有效性。
共筛选了 477 篇同行评议研究和 13 份报告。有 103 项研究被纳入审查，确定了 8 个类别中的 109 项干预措施：政策和委托（n=9）；分类（n=1）；指南和工具包（n=22）；监测和反馈（n=17）；专业参与和培训（n=19）；处方工具（n=12）；公众意识（n=17）；劳动力和治理（n=12）。大多数干预措施缺乏高质量的有效性证据。评估主要侧重于临床、微生物学或抗生素使用结果或干预措施的实施，通常评估干预措施如何被认为影响行为。只有 16 项干预措施的研究量化了对处方的影响，其中 6 项报告了减少。结构层面的干预措施报告了最大的减少，归因于一项政策和委托干预措施（初级保健财务激励措施）。医院报告的行为干预措施（指南和工具包）的影响最大。
许多干预措施都针对抗生素的使用，每个干预措施都同时在卫生系统中拉动不同的杠杆。基于这些研究，结构层面的干预措施可能具有最大的影响。总的来说，干预措施的组合可能解释了英格兰处方量的下降，但没有直接的因果关系证据。
