在四个欧洲国家（ImpresU）实施一项定制的多方面抗生素管理干预措施，以改善虚弱老年人尿路感染的抗生素处方：一项实用的集群随机对照试验的过程评估。

Implementation of a tailored multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for urinary tract infections in frail older adults (ImpresU) in four European countries: a process evaluation alongside a pragmatic cluster randomized controlled trial.

机构信息

Department of Medicine for Older People, Amsterdam, UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.

Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

出版信息

Trials. 2024 Oct 18;25(1):691. doi: 10.1186/s13063-024-08545-4.

DOI:10.1186/s13063-024-08545-4

PMID:39425170

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11488242/

Abstract

BACKGROUND

We previously performed a pragmatic cluster randomized controlled trial (RCT) in general practices and older adult care organizations in Poland, the Netherlands, Norway, and Sweden. We found that a multifaceted antibiotic stewardship intervention (ASI) substantially reduced antibiotic use for suspected urinary tract infections (UTIs) in frail older adults compared with usual care. We aimed to evaluate the implementation process of the ASI to provide recommendations for clinical practice.

METHODS

We conducted a process evaluation alongside the cluster RCT. The ASI consisted of a decision-tool and a toolbox, which were implemented using a participatory-action-research (PAR) approach with sessions for education and evaluation. We documented the implementation process of the intervention and administered a questionnaire to health care professionals (HCPs) from participating organizations in the intervention and usual care clusters. We evaluated the multiple components of the intervention and its implementation following a structured framework.

RESULTS

The questionnaire was completed by 254 HCPs from the 38 participating clusters. All components were largely delivered according to plan and evaluated as useful. The decision-tool and toolbox materials were reported to facilitate decision-making on UTIs. Regarding the PAR approach, educational sessions focusing on the distinction between UTIs and asymptomatic bacteriuria were held in all 19 intervention clusters. In 17 out of these 19 clusters, evaluation sessions took place, which were reported to help remind HCPs to implement the ASI. During both sessions, HCPs valued the reflection that took place and the resulting awareness of their behavior. It allowed them to explore implementation barriers and to tailor their local implementation process to overcome these. For example, HCPs organized extra educational sessions or revised local policies to incorporate the use of the decision-tool. Various HCPs took key roles in implementation. Staff changes and the COVID-19 pandemic were important contextual barriers.

CONCLUSIONS

We found each component of the multifaceted ASI and its implementation to have added value in the process to improve antibiotic prescribing for suspected UTIs in a heterogeneous older adult care setting. We recommend using a multifaceted, multidisciplinary approach that enables HCPs to reflect on their current practice and accordingly tailor local implementation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03970356. Registered on May 31, 2019.

摘要

背景

我们之前在波兰、荷兰、挪威和瑞典的一般实践和老年护理组织中进行了一项实用的集群随机对照试验（RCT）。我们发现，与常规护理相比，多方面的抗生素管理干预（ASI）可大大减少对脆弱老年人疑似尿路感染（UTI）的抗生素使用。我们旨在评估 ASI 的实施过程，为临床实践提供建议。

方法

我们在 RCT 中进行了一项过程评估。ASI 由决策工具和工具包组成，使用参与式行动研究（PAR）方法实施，包括教育和评估会议。我们记录了干预措施的实施过程，并向参与干预和常规护理集群的组织的医疗保健专业人员（HCP）发放了问卷。我们按照结构化框架评估了干预措施的多个组成部分及其实施情况。

结果

来自 38 个参与集群的 254 名 HCP 完成了问卷。所有组成部分都基本按照计划进行并被评估为有用。决策工具和工具包材料据报道有助于对 UTI 做出决策。关于 PAR 方法，在所有 19 个干预集群中都举行了重点关注 UTI 和无症状菌尿之间区别的教育课程。在这 19 个集群中的 17 个集群中，都举行了评估会议，这些会议被认为有助于提醒 HCP 实施 ASI。在这两个会议期间，HCP 都非常重视进行的反思，以及由此产生的对其行为的认识。这使他们能够探讨实施障碍，并调整其当地实施过程以克服这些障碍。例如，HCP 组织了额外的教育课程或修改了当地政策，以纳入决策工具的使用。各种 HCP 在实施过程中都发挥了关键作用。人员变动和 COVID-19 大流行是重要的背景障碍。