The online version of this article (https://doi.org/10.1186/s12874-017-0455-9) contains supplementary material, which is available to authorized users.
Overuse of antibiotics contributes to the global threat of antimicrobial resistance. Antibiotic stewardship interventions address this threat by reducing the use of antibiotics in occasions or doses unlikely to be effective. We aimed to develop an evidence-based, theory-informed, intervention to reduce antibiotic prescriptions in primary care for childhood respiratory tract infections (RTI). This paper describes our methods for doing so.
Green and Krueter’s Precede/Proceed logic model was used as a framework to integrate findings from a programme of research including 5 systematic reviews, 3 qualitative studies, and 1 cohort study. The model was populated using a strength of evidence approach, and developed with input from stakeholders including clinicians and parents.
The synthesis produced a series of evidence-based statements summarizing the quantitative and qualitative evidence for intervention elements most likely to result in changes in clinician behaviour. Current evidence suggests that interventions which reduce clinical uncertainty, reduce clinician/parent miscommunication, elicit parent concerns, make clear delayed or no-antibiotic recommendations, and provide clinicians with alternate treatment actions have the best chance of success. We designed a web-based within-consultation intervention to reduce clinician uncertainty and pressure to prescribe, designed to be used when children with RTI present to a prescribing clinician in primary care.
We provide a worked example of methods for the development of future complex interventions in primary care, where multiple factors act on multiple actors within a complex system. Our synthesis provided intervention guidance, recommendations for practice, and highlighted evidence gaps, but questions remain about how best to implement these recommendations. The funding structure which enabled a single team of researchers to work on a multi-method programme of related studies (NIHR Programme Grant scheme) was key in our success.
The feasibility study accompanying this intervention was prospectively registered with the ISRCTN registry (ISRCTN23547970), on 27 June 2014.
WHO: WHO Global Strategy for Containment of Antimicrobial Resistance. In . Geneva: World Health Organisation; 2001.
The White House : National strategy for combating antibioticresistant bacteria In . Washington DC, USA: The White House; 2014.
Department of Health: UK Five Year Antimicrobial Resistance Strategy 2013 to 2018. In . Edited by Deapartment of Health DotEaRA, Northern Ireland Executive, Welsh Government, The Scottish Government London, UK: Department of Health; 2013.
Shallcross LJ, Howard SJ, Fowler T, Davies SC. Tackling the threat of antimicrobial resistance: from policy to sustainable action. Philos Trans R Soc Lond Ser B Biol Sci. 2015;370(1670):20140082. CrossRef
Drekonja D, Filice G, Greer N, Olson A, MacDonald R, Rutks I, Wilt TJ. VA evidence-based synthesis program reports. In: Antimicrobial Stewardship Programs in Outpatient Settings: A Systematic Review. Department of Veterans Affairs: Washington (DC); 2014.
Gould IM, Lawes T. Antibiotic stewardship: prescribing social norms. Lancet (London, England). 2016;387(10029):1699–701. CrossRef
Tannen D, Wallat C. Interactive frames and knowledge schemas in interaction: examples from a medical examination/interview. Soc Psychol Q. 1987;50(2):205–16. CrossRef
Stivers T, Mangione-Smith R, Elliott MN, McDonald L, Heritage J. Why do physicians think parents expect antibiotics? What parents report vs what physicians believe. J Fam Pract. 2003;52(2):140–8. PubMed
Mangione-Smith R, McGlynn EA, Elliott MN, McDonald L, Franz CE, Kravitz RL. Parent expectations for antibiotics, physician-parent communication, and satisfaction. Archives of Pediatrics & Adolescent Medicine. 2001;155(7):800–6. CrossRef
MRC: Developing and evaluating complex interventions: new guidance. In . London: Medical Research Council; 2008.
Aventin A, Lohan M, O'Halloran P, Henderson M. Design and development of a film-based intervention about teenage men and unintended pregnancy: applying the Medical Research Council framework in practice. Evaluation and program planning. 2015;49c:19–30. CrossRef
Wight D, Wimbush E, Jepson R, Doi L. Six steps in quality intervention development (6SQuID). J Epidemiol Community Health. 2015:1–6.
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ (Clinical research ed). 2014;348:g1687.
Redmond NM, Davies R, Christensen H, Blair PS, Lovering AM, Leeming JP, Muir P, Vipond B, Thornton H, Fletcher M, et al. The TARGET cohort study protocol: a prospective primary care cohort study to derive and validate a clinical prediction rule to improve the targeting of antibiotics in children with respiratory tract illnesses. BMC Health Serv Res. 2013;13:322. CrossRefPubMedPubMedCentral
Vodicka TA, Thompson M, Lucas P, Heneghan C, Blair PS, Buckley DI, Redmond N, Hay AD. Team TP: reducing antibiotic prescribing for children with respiratory tract infections in primary care: a systematic review. The British journal of general practice : the journal of the Royal College of General Practitioners. 2013;63(612):e445–54. CrossRef
Cabral C, Lucas PJ, Ingram J, Hay AD, Horwood J. "It's safer to ..." parent consulting and clinician antibiotic prescribing decisions for children with respiratory tract infections: An analysis across four qualitative studies. Social science & medicine. 2015;136-137C:156–64. CrossRef
Lucas PJ, Cabral C, Hay AD, Horwood J. A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care. Scand J Prim Health Care. 2015:1–10.
Turnbull SL, Redmond NM, Lucas P, Cabral C, Ingram J, Hollinghurst S, Hay AD, Peters TJ, Horwood J, Little P, et al. The CHICO (Children’s Cough) Trial protocol: a feasibility randomised controlled trial investigating the clinical and cost-effectiveness of a complex intervention to improve the management of children presenting to primary care with acute respiratory tract infection. 2015;5(9):e008615.
Hay AD, Redmond NM, Turnbull S, Christensen H, Thornton H, et al. Development and internal validation of a clinical rule to improve antibiotic use in children presenting to primary care with acute respiratory tract infection and cough: the ‘TARGET’ prognostic cohort study. Lancet Respiratory Medicine. 4(11):902–10. doi: 10.1016/S2213-2600(16)30223-5. Epub 2016 Sept 1.
Hay AD, Redmond NM, Turnbull S, Christensen H, Thornton H, Little P, Thompson M, Delaney B, Lovering AM, Muir P, et al. Development and internal validation of a clinical rule to improve antibiotic use in children presenting to primary care with acute respiratory tract infection and cough: a prognostic cohort study. The Lancet Respiratory Medicine. 4(11):902–10.
Michie S. Designing and implementing behaviour change interventions to improve population health. Journal of Health Services Research & Policy. 2008;13(3):64–9. CrossRef
Michie S, Abraham C. Interventions to change health behaviours: evidence-based or evidence-inspired? Psychol Health. 2004;19(1):29–49.
Blair PS, Turnbull S, Ingram JC, Redmond NM, Lucas PJ, Cabral C, Hollinghurst S, Dixon P, Peters TJ, Horwood J, Little P, Francis N, Gilbertson A, Jameson C, Hay AD. Feasibility cluster randomised controlled trial of a within-consultation intervention to reduce antibiotic prescribing for children presenting to primary care with acute respiratory tract infection and cough. BMJ Open. 2017;7(5):e014506. doi: 10.1136/bmjopen-2016-014506.
Hay AD, Redmond NM, Turnbull S, Christensen H, Thornton H, Little P, Thompson M, Delaney B, Lovering AM, Muir P, et al. Development and internal validation of a clinical rule to improve antibiotic use in children presenting to primary care with acute respiratory tract infection and cough: a prognostic cohort study. Lancet Respir Med. 2016.
Cabral C, Horwood J, Hay AD, Lucas P. Decision making in consultations for RTI in children: a systematic review and meta-ethnographic synthesis of qualitative data. In: Society for Academic Primary Care Annual Conference: Glasgow: Society for Academic Primary Care; 2012.
Green LW, Kreuter M. Health program planning: an educational and ecological approach. New York: McGraw-Hill; 2005.
The Precede-Proceed Model of Health Program Planning & Evaluation. http://lgreen.net/precede.htm.
Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions: Health Psychology. 2008;27(3):379–87.
Weinstein ND. Testing four competing theories of health-protective behavior. Health Psychology. 1993;12(4):324–33.
Conner M, Norman P. Predicting health behaviour. Maidenhead: Open University Press; 2005.
Fielden SJ, Rusch ML, Masinda MT, Sands J, Frankish J, Evoy B. Key considerations for logic model development in research partnerships: a Canadian case study. Evaluation & Program Planning. 2007;30(2):115–24. CrossRef
Gugiu PC, Rodriguez-Campos L. Semi-structured interview protocol for constructing logic models. Evaluation & Program Planning. 2007;30(4):339–50. CrossRef
Helitzer D, Hollis C, de Hernandez BU, Sanders M, Roybal S, Van Deusen I. Evaluation for community-based programs: the integration of logic models and factor analysis. Evaluation & Program Planning. 2010;33(3):223–33. CrossRef
Medeiros LC, Butkus SN, Chipman H, Cox RH, Jones L, Little D. A logic model framework for community nutrition education. Journal of Nutrition Education & Behavior. 2005;37(4):197–202. CrossRef
Toumbourou JW, Bamberg JH. Family recovery from youth substance use related problems: a pilot study of the BEST plus program. Substance Use & Misuse. 2008;43(12–13):1829–43. CrossRef
NICE. Respiratory tract infections – antibiotic prescribing prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. In: NICE clinical guideline 69. London: National Institute for Health and Clinical Excellence; 2008.
Edwards J, Charani E, Sevdalis N, Alexandrou B, Sibley E, Mullett D, Loveday H, Drumright L, Holmes A, Edwards R, Charani E, Sevdalis N, Alexandrou B, Sibley E, et al. Optimisation of infection prevention and control in acute health care by use of behaviour change: a systematic review. Lancet Infect Dis. 2012;12(4):318–29. CrossRefPubMed
Cross EL, Tolfree R, Kipping R. Systematic review of public-targeted communication interventions to improve antibiotic use. J Antimicrob Chemother. 2017;72(4):975–87. PubMed
Hallsworth M, Chadborn T, Sallis A, Sanders M, Berry D, Greaves F, Clements L, Davies SC. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet (London, England). 2016;387(10029):1743–52. CrossRef
O'Brien N, Heaven B, Teal G, Evans EH, Cleland C, Moffatt S, Sniehotta FF, White M, Mathers JC, Moynihan P. Integrating evidence from systematic reviews, qualitative research, and expert knowledge using co-design techniques to develop a web-based intervention for people in the retirement transition. J Med Internet Res. 2016;18(8):e210. CrossRefPubMedPubMedCentral
Vervloet M, Meulepas MA, Cals JW, Eimers M, van der Hoek LS, van Dijk L. Reducing antibiotic prescriptions for respiratory tract infections in family practice: results of a cluster randomized controlled trial evaluating a multifaceted peer-group-based intervention. NPJ primary care respiratory medicine. 2016;26:15083. CrossRefPubMedPubMedCentral
Juszczyk D, Charlton J, McDermott L, Soames J, Sultana K, Ashworth M, Fox R, Hay AD, Little P, Moore MV, et al. Electronically delivered, multicomponent intervention to reduce unnecessary antibiotic prescribing for respiratory infections in primary care: a cluster randomised trial using electronic health records-REDUCE trial study original protocol. BMJ Open. 2016;6(8):e010892. CrossRefPubMedPubMedCentral
Guthrie B, Kavanagh K, Robertson C, Barnett K, Treweek S, Petrie D, Ritchie L, Bennie M. Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial. BMJ (Clinical research ed). 2016;354:i4079.
- Development of an intervention to reduce antibiotic use for childhood coughs in UK primary care using critical synthesis of multi-method research
Patricia J. Lucas
Niamh M. Redmond
Sophie L. Turnbull
Alastair D. Hay
- BioMed Central
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