Prioritizing research areas for antibiotic stewardship programmes in hospitals: a behavioural perspective consensus paper

Magdalena Rzewuska (Corresponding Author), Esmita Charani, Janet E. Clarkson, Peter G. Davey, Eilidh M. Duncan, Jill J. Francis, Katie Gillies, Winfried V. Kern, Fabiana Lorencatto, Charis A. Marwick, Jo McEwen, Ralph Möhler, Andrew M. Morris, Craig R. Ramsay, Susan Rogers Van Katwyk, Brita Skodvin, Ingrid Smith, Kathryn N. Suh, Jeremy M. Grimshaw, The JPIAMR (Joint Programming Initiative on Antimicrobial Resistance) Working Group on Behavioural Approaches to Antibiotic Stewardship Programmes

Research output: Contribution to journalArticle

9 Citations (Scopus)
9 Downloads (Pure)

Abstract

Scope

Antibiotic stewardship programmes (ASPs) are necessary in hospitals to improve the judicious use of antibiotics. While ASPs require complex change of key behaviours on individual, team, organisation and policy levels, evidence from the behavioural sciences is underutilised in antibiotic stewardship studies across the world, including high-income countries (HICs). A consensus procedure was performed to propose research priority areas for optimising effective implementation of ASPs in hospital settings, using a behavioural perspective.

Methods

A workgroup for behavioural approaches to ASPs was convened in response to the fourth call for leading expert network proposals by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). Eighteen clinical and academic specialists in antibiotic stewardship, implementation science and behaviour change from four high-income countries with publicly-funded health care systems (that is Canada, Germany, Norway and the UK), met face-to-face to agree on broad research priority areas using a structured consensus method.

Question addressed and recommendations

The consensus process on the 10 identified research priority areas resulted in recommendations that need urgent scientific interest and funding to optimise effective implementation of antibiotic stewardship programmes for hospital inpatients in HICs with publicly-funded health care systems. We suggest and detail, behavioural science evidence-guided research efforts in the following areas: 1) Comprehensively identifying barriers and facilitators to implementing antibiotic stewardship programmes and clinical recommendations intended to optimise antibiotic prescribing; 2) Identifying actors (‘who’) and actions (‘what needs to be done’) of antibiotic stewardship programmes and clinical teams; 3) Synthesising available evidence to support future research and planning for antibiotic stewardship programmes; 4) Specifying the activities in current antibiotic stewardship programmes with the purpose of defining a ‘control group’ for comparison with new initiatives; 5) Defining a balanced set of outcomes and measures to evaluate the effects of interventions focused on reducing unnecessary exposure to antibiotics; 6) Conducting robust evaluations of antibiotic stewardship programmes with built-in process evaluations and fidelity assessments; 7) Defining and designing antibiotic stewardship programmes; 8) Establishing the evidence base for impact of antibiotic stewardship programmes on resistance; 9) Investigating the role and impact of government and policy contexts on antibiotic stewardship programmes; and 10) Understanding what matters to patients in antibiotic stewardship programmes in hospitals.

Assessment, revisions and updates of our priority-setting exercise should be considered, at intervals of 2 years. To propose research priority areas in low- and medium income countries (LIMCs), the methodology reported here could be applied.
Original languageEnglish
Pages (from-to)163-168
Number of pages6
JournalClinical Microbiology and Infection
Volume25
Issue number2
Early online date7 Sep 2018
DOIs
Publication statusPublished - Feb 2019

Fingerprint

Consensus
Anti-Bacterial Agents
Research
Behavioral Sciences
Delivery of Health Care
Norway
Canada
Germany
Inpatients
Outcome Assessment (Health Care)
Organizations
Exercise

Keywords

  • antimicrobial stewardship
  • research priorities
  • nominal group technique
  • multidisciplinary approach
  • behavioural approach
  • Nominal group technique
  • Research priorities
  • Multidisciplinary approach
  • Antimicrobial stewardship
  • Behavioural approach
  • Anti-Bacterial Agents/administration & dosage
  • Antimicrobial Stewardship
  • Humans
  • Infection Control
  • Consensus
  • Practice Patterns, Physicians'
  • Hospitals
  • Research Design

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Rzewuska, M., Charani, E., Clarkson, J. E., Davey, P. G., Duncan, E. M., Francis, J. J., ... The JPIAMR (Joint Programming Initiative on Antimicrobial Resistance) Working Group on Behavioural Approaches to Antibiotic Stewardship Programmes (2019). Prioritizing research areas for antibiotic stewardship programmes in hospitals: a behavioural perspective consensus paper. Clinical Microbiology and Infection, 25(2), 163-168. https://doi.org/10.1016/j.cmi.2018.08.020

Prioritizing research areas for antibiotic stewardship programmes in hospitals : a behavioural perspective consensus paper. / Rzewuska, Magdalena (Corresponding Author); Charani, Esmita; Clarkson, Janet E.; Davey, Peter G.; Duncan, Eilidh M.; Francis, Jill J.; Gillies, Katie; Kern, Winfried V.; Lorencatto, Fabiana; Marwick, Charis A.; McEwen, Jo; Möhler, Ralph; Morris, Andrew M.; Ramsay, Craig R.; Rogers Van Katwyk, Susan; Skodvin, Brita; Smith, Ingrid; Suh, Kathryn N.; Grimshaw, Jeremy M.; The JPIAMR (Joint Programming Initiative on Antimicrobial Resistance) Working Group on Behavioural Approaches to Antibiotic Stewardship Programmes.

In: Clinical Microbiology and Infection, Vol. 25, No. 2, 02.2019, p. 163-168.

Research output: Contribution to journalArticle

Rzewuska, M, Charani, E, Clarkson, JE, Davey, PG, Duncan, EM, Francis, JJ, Gillies, K, Kern, WV, Lorencatto, F, Marwick, CA, McEwen, J, Möhler, R, Morris, AM, Ramsay, CR, Rogers Van Katwyk, S, Skodvin, B, Smith, I, Suh, KN, Grimshaw, JM & The JPIAMR (Joint Programming Initiative on Antimicrobial Resistance) Working Group on Behavioural Approaches to Antibiotic Stewardship Programmes 2019, 'Prioritizing research areas for antibiotic stewardship programmes in hospitals: a behavioural perspective consensus paper', Clinical Microbiology and Infection, vol. 25, no. 2, pp. 163-168. https://doi.org/10.1016/j.cmi.2018.08.020
Rzewuska, Magdalena ; Charani, Esmita ; Clarkson, Janet E. ; Davey, Peter G. ; Duncan, Eilidh M. ; Francis, Jill J. ; Gillies, Katie ; Kern, Winfried V. ; Lorencatto, Fabiana ; Marwick, Charis A. ; McEwen, Jo ; Möhler, Ralph ; Morris, Andrew M. ; Ramsay, Craig R. ; Rogers Van Katwyk, Susan ; Skodvin, Brita ; Smith, Ingrid ; Suh, Kathryn N. ; Grimshaw, Jeremy M. ; The JPIAMR (Joint Programming Initiative on Antimicrobial Resistance) Working Group on Behavioural Approaches to Antibiotic Stewardship Programmes. / Prioritizing research areas for antibiotic stewardship programmes in hospitals : a behavioural perspective consensus paper. In: Clinical Microbiology and Infection. 2019 ; Vol. 25, No. 2. pp. 163-168.
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abstract = "ScopeAntibiotic stewardship programmes (ASPs) are necessary in hospitals to improve the judicious use of antibiotics. While ASPs require complex change of key behaviours on individual, team, organisation and policy levels, evidence from the behavioural sciences is underutilised in antibiotic stewardship studies across the world, including high-income countries (HICs). A consensus procedure was performed to propose research priority areas for optimising effective implementation of ASPs in hospital settings, using a behavioural perspective.MethodsA workgroup for behavioural approaches to ASPs was convened in response to the fourth call for leading expert network proposals by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). Eighteen clinical and academic specialists in antibiotic stewardship, implementation science and behaviour change from four high-income countries with publicly-funded health care systems (that is Canada, Germany, Norway and the UK), met face-to-face to agree on broad research priority areas using a structured consensus method.Question addressed and recommendationsThe consensus process on the 10 identified research priority areas resulted in recommendations that need urgent scientific interest and funding to optimise effective implementation of antibiotic stewardship programmes for hospital inpatients in HICs with publicly-funded health care systems. We suggest and detail, behavioural science evidence-guided research efforts in the following areas: 1) Comprehensively identifying barriers and facilitators to implementing antibiotic stewardship programmes and clinical recommendations intended to optimise antibiotic prescribing; 2) Identifying actors (‘who’) and actions (‘what needs to be done’) of antibiotic stewardship programmes and clinical teams; 3) Synthesising available evidence to support future research and planning for antibiotic stewardship programmes; 4) Specifying the activities in current antibiotic stewardship programmes with the purpose of defining a ‘control group’ for comparison with new initiatives; 5) Defining a balanced set of outcomes and measures to evaluate the effects of interventions focused on reducing unnecessary exposure to antibiotics; 6) Conducting robust evaluations of antibiotic stewardship programmes with built-in process evaluations and fidelity assessments; 7) Defining and designing antibiotic stewardship programmes; 8) Establishing the evidence base for impact of antibiotic stewardship programmes on resistance; 9) Investigating the role and impact of government and policy contexts on antibiotic stewardship programmes; and 10) Understanding what matters to patients in antibiotic stewardship programmes in hospitals.Assessment, revisions and updates of our priority-setting exercise should be considered, at intervals of 2 years. To propose research priority areas in low- and medium income countries (LIMCs), the methodology reported here could be applied.",
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author = "Magdalena Rzewuska and Esmita Charani and Clarkson, {Janet E.} and Davey, {Peter G.} and Duncan, {Eilidh M.} and Francis, {Jill J.} and Katie Gillies and Kern, {Winfried V.} and Fabiana Lorencatto and Marwick, {Charis A.} and Jo McEwen and Ralph M{\"o}hler and Morris, {Andrew M.} and Ramsay, {Craig R.} and {Rogers Van Katwyk}, Susan and Brita Skodvin and Ingrid Smith and Suh, {Kathryn N.} and Grimshaw, {Jeremy M.} and {The JPIAMR (Joint Programming Initiative on Antimicrobial Resistance) Working Group on Behavioural Approaches to Antibiotic Stewardship Programmes}",
note = "This project has received funding from the Research Council of Norway (RCN) through the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) call 4 (2016). Costs included travel costs, running face to-face meetings and dissemination of results. The HSRU is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. JMG holds a Canada research Chair in Health Knowledge Transfer an Uptake. EC is funded by National Institute of Health Research Imperial Biomedical Research Centre and the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and the Economic and Social Research Council. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.",
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T1 - Prioritizing research areas for antibiotic stewardship programmes in hospitals

T2 - a behavioural perspective consensus paper

AU - Rzewuska, Magdalena

AU - Charani, Esmita

AU - Clarkson, Janet E.

AU - Davey, Peter G.

AU - Duncan, Eilidh M.

AU - Francis, Jill J.

AU - Gillies, Katie

AU - Kern, Winfried V.

AU - Lorencatto, Fabiana

AU - Marwick, Charis A.

AU - McEwen, Jo

AU - Möhler, Ralph

AU - Morris, Andrew M.

AU - Ramsay, Craig R.

AU - Rogers Van Katwyk, Susan

AU - Skodvin, Brita

AU - Smith, Ingrid

AU - Suh, Kathryn N.

AU - Grimshaw, Jeremy M.

AU - The JPIAMR (Joint Programming Initiative on Antimicrobial Resistance) Working Group on Behavioural Approaches to Antibiotic Stewardship Programmes

N1 - This project has received funding from the Research Council of Norway (RCN) through the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) call 4 (2016). Costs included travel costs, running face to-face meetings and dissemination of results. The HSRU is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. JMG holds a Canada research Chair in Health Knowledge Transfer an Uptake. EC is funded by National Institute of Health Research Imperial Biomedical Research Centre and the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and the Economic and Social Research Council. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

PY - 2019/2

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N2 - ScopeAntibiotic stewardship programmes (ASPs) are necessary in hospitals to improve the judicious use of antibiotics. While ASPs require complex change of key behaviours on individual, team, organisation and policy levels, evidence from the behavioural sciences is underutilised in antibiotic stewardship studies across the world, including high-income countries (HICs). A consensus procedure was performed to propose research priority areas for optimising effective implementation of ASPs in hospital settings, using a behavioural perspective.MethodsA workgroup for behavioural approaches to ASPs was convened in response to the fourth call for leading expert network proposals by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). Eighteen clinical and academic specialists in antibiotic stewardship, implementation science and behaviour change from four high-income countries with publicly-funded health care systems (that is Canada, Germany, Norway and the UK), met face-to-face to agree on broad research priority areas using a structured consensus method.Question addressed and recommendationsThe consensus process on the 10 identified research priority areas resulted in recommendations that need urgent scientific interest and funding to optimise effective implementation of antibiotic stewardship programmes for hospital inpatients in HICs with publicly-funded health care systems. We suggest and detail, behavioural science evidence-guided research efforts in the following areas: 1) Comprehensively identifying barriers and facilitators to implementing antibiotic stewardship programmes and clinical recommendations intended to optimise antibiotic prescribing; 2) Identifying actors (‘who’) and actions (‘what needs to be done’) of antibiotic stewardship programmes and clinical teams; 3) Synthesising available evidence to support future research and planning for antibiotic stewardship programmes; 4) Specifying the activities in current antibiotic stewardship programmes with the purpose of defining a ‘control group’ for comparison with new initiatives; 5) Defining a balanced set of outcomes and measures to evaluate the effects of interventions focused on reducing unnecessary exposure to antibiotics; 6) Conducting robust evaluations of antibiotic stewardship programmes with built-in process evaluations and fidelity assessments; 7) Defining and designing antibiotic stewardship programmes; 8) Establishing the evidence base for impact of antibiotic stewardship programmes on resistance; 9) Investigating the role and impact of government and policy contexts on antibiotic stewardship programmes; and 10) Understanding what matters to patients in antibiotic stewardship programmes in hospitals.Assessment, revisions and updates of our priority-setting exercise should be considered, at intervals of 2 years. To propose research priority areas in low- and medium income countries (LIMCs), the methodology reported here could be applied.

AB - ScopeAntibiotic stewardship programmes (ASPs) are necessary in hospitals to improve the judicious use of antibiotics. While ASPs require complex change of key behaviours on individual, team, organisation and policy levels, evidence from the behavioural sciences is underutilised in antibiotic stewardship studies across the world, including high-income countries (HICs). A consensus procedure was performed to propose research priority areas for optimising effective implementation of ASPs in hospital settings, using a behavioural perspective.MethodsA workgroup for behavioural approaches to ASPs was convened in response to the fourth call for leading expert network proposals by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). Eighteen clinical and academic specialists in antibiotic stewardship, implementation science and behaviour change from four high-income countries with publicly-funded health care systems (that is Canada, Germany, Norway and the UK), met face-to-face to agree on broad research priority areas using a structured consensus method.Question addressed and recommendationsThe consensus process on the 10 identified research priority areas resulted in recommendations that need urgent scientific interest and funding to optimise effective implementation of antibiotic stewardship programmes for hospital inpatients in HICs with publicly-funded health care systems. We suggest and detail, behavioural science evidence-guided research efforts in the following areas: 1) Comprehensively identifying barriers and facilitators to implementing antibiotic stewardship programmes and clinical recommendations intended to optimise antibiotic prescribing; 2) Identifying actors (‘who’) and actions (‘what needs to be done’) of antibiotic stewardship programmes and clinical teams; 3) Synthesising available evidence to support future research and planning for antibiotic stewardship programmes; 4) Specifying the activities in current antibiotic stewardship programmes with the purpose of defining a ‘control group’ for comparison with new initiatives; 5) Defining a balanced set of outcomes and measures to evaluate the effects of interventions focused on reducing unnecessary exposure to antibiotics; 6) Conducting robust evaluations of antibiotic stewardship programmes with built-in process evaluations and fidelity assessments; 7) Defining and designing antibiotic stewardship programmes; 8) Establishing the evidence base for impact of antibiotic stewardship programmes on resistance; 9) Investigating the role and impact of government and policy contexts on antibiotic stewardship programmes; and 10) Understanding what matters to patients in antibiotic stewardship programmes in hospitals.Assessment, revisions and updates of our priority-setting exercise should be considered, at intervals of 2 years. To propose research priority areas in low- and medium income countries (LIMCs), the methodology reported here could be applied.

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