Elizondo-Alzola Usue, Rocha Claudio, Leache Leire, León-García Montserrat, Saiz Luis Carlos, Solà Ivan, Montesinos-Guevara Camila, Meade Adriana-Gabriela, Boldú Andrea, Bolíbar Ignasi, Niño-de-Guzmán Ena, Alonso-Coello Pablo
Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain.
Primary Care Pharmacy, Debagoiena Integrated Health Organisation, Osakidetza Basque Health Service, Arrasate, Spain.
BMC Pediatr. 2025 May 26;25(1):421. doi: 10.1186/s12887-025-05688-4.
Inappropriate antibiotic prescription in paediatric uncomplicated acute respiratory tract infections (ARTIs) in primary care (PC) settings contributes to antimicrobial resistance. We aimed (1) to identify and describe educational interventions and their components to optimise antibiotic prescription for paediatric uncomplicated ARTIs in PC, and (2) to map contextual factors that may influence antibiotic prescription and the implementation of interventions.
We searched three electronic databases (Medline, CINAHL and Epistemonikos) to identify reviews on the effectiveness of educational interventions and contextual factors, for optimising antibiotic prescription (Concept) in paediatric uncomplicated ARTIs (Population) in PC (Context). We included reviews that reported explicitly the search strategy used. Two previously calibrated reviewers independently screened the literature, extracted data, and assessed the methodological limitations. We applied the "best-fit framework synthesis approach", based on the main constructs of the Consolidated Framework for Implementation Research, and coded the data deductively by groups of analysis for reviews reporting effectiveness (e.g. antibiotic or consultation rate) or by thematic synthesis for reviews reporting contextual factors (e.g. healthcare professionals' knowledge) based on a logic model.
We identified 11 reviews evaluating education intervention and their characteristics, including 182 interventions with at least one educational component (educational intervention plus another type, educational or non-educational), with 136 providing information on characteristics and effectiveness. Successful interventions' characteristics were related to the kind of intervention (e.g. communication skill training), mode of delivery (e.g. face to face), and target population (e.g. parents/caregivers). From the 22 reviews on contextual factors, healthcare professionals' attitudes and perceptions, knowledge, and health system and professionals' teams' organization (inner setting), were the most frequent themes; less information was available on individuals´ characteristics (parents/children) and on outer setting (e.g. policies).
We identified a large number of heterogeneous educational interventions. Combining educational interventions plus another type targeting both parents/caregivers and healthcare professionals, and considering their needs and their context may improve antibiotic prescribing in children. Further research is needed on consultation rate, knowledge, attitudes, and satisfaction outcomes and contextual factors, as well as on the cost-effectiveness of the interventions.
The protocol was published in OSF iRegistries in May 2021 (Elizondo-Alzola, U).
基层医疗环境中，儿科非复杂性急性呼吸道感染（ARTIs）的不恰当抗生素处方会导致抗菌药物耐药性。我们旨在：（1）识别并描述教育干预措施及其组成部分，以优化基层医疗中儿科非复杂性ARTIs的抗生素处方；（2）梳理可能影响抗生素处方及干预措施实施的背景因素。
我们检索了三个电子数据库（Medline、CINAHL和Epistemonikos），以识别关于教育干预措施有效性和背景因素的综述，这些干预措施旨在优化基层医疗中儿科非复杂性ARTIs（研究对象）的抗生素处方（概念）。我们纳入了明确报告所使用检索策略的综述。两名先前经过校准的评审员独立筛选文献、提取数据并评估方法学局限性。我们基于实施研究综合框架的主要构建要素，应用“最佳拟合框架综合法”，并根据逻辑模型，对报告有效性（如抗生素或会诊率）的综述按分析组进行演绎编码，对报告背景因素（如医疗保健专业人员的知识）的综述进行主题综合编码。
我们识别出11篇评估教育干预措施及其特征的综述，包括182项至少包含一个教育组成部分的干预措施（教育干预措施加另一种类型，教育或非教育），其中136项提供了有关特征和有效性的信息。成功干预措施的特征与干预类型（如沟通技能培训）、实施方式（如面对面）和目标人群（如父母/照顾者）有关。在22篇关于背景因素的综述中，医疗保健专业人员的态度和认知、知识以及卫生系统和专业人员团队的组织（内部环境）是最常见的主题；关于个体特征（父母/儿童）和外部环境（如政策）的信息较少。
我们识别出大量异质性教育干预措施。将教育干预措施与针对父母/照顾者和医疗保健专业人员的另一种类型相结合，并考虑他们的需求和背景，可能会改善儿童抗生素处方。需要进一步研究会诊率、知识、态度和满意度结果以及背景因素，以及干预措施的成本效益。
该方案于2021年5月发表于OSF iRegistries（埃利桑多 - 阿尔佐拉，U）。
