Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena.

Regina Poss-Doering,Martina Kamradt,Lukas Kühn,Michel Wensing,Joachim Szecsenyi,Edith Andres,Anna Stürmlinger,Petra Kaufmann-Kolle,Veit Wambach,Katharina Glassen,Lutz Bader

doi:10.3390/antibiotics9120878

Abstract

The cluster randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance, 2017–2020) promoted appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation assessed determinants of practice and explored factors associated with antibiotic prescribing patterns. This work describes its findings on uptake and impacts of the complex intervention program and indicates potential implementation into routine care. In a nested mixed-methods approach, a three-wave study-specific survey for participating physicians and medical assistants assessed potential impacts and uptake of the complex intervention program. Stakeholders received a one-time online questionnaire to reflect on network-related aspects. Semi-structured, open-ended interviews, with a purposive sample of physicians, medical assistants and stakeholders, explored program component acceptance for daily practice and perceived sustainability of intervention component effects. Intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for educational components: feedback reports, background information, e-learning modules and disease-specific quality circles (QCs). Participation in PCNs was seen as the motivational factor for guideline-oriented patient care and adoption of new routines. Future approaches to fostering appropriate antibiotics use by targeting health literacy competencies and clinician’s therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.

Highlights

Antibiotics are powerful medicines that can mitigate bacterial infections and save lives when used appropriately
In Germany, where about 90% of the used antibiotics are prescribed in ambulatory care, measures have been launched to foster the appropriate antibiotics use and aim at a sustainable reduction of antibiotics misuse and overuse
Gender distribution in physicians in T0 was at 34% of female respondents (32% in to September 2019 (T2))

Summary

Introduction

Antibiotics are powerful medicines that can mitigate bacterial infections and save lives when used appropriately. In Germany, where about 90% of the used antibiotics are prescribed in ambulatory care, measures have been launched to foster the appropriate antibiotics use and aim at a sustainable reduction of antibiotics misuse and overuse In this context, a national strategy is being pursued [5,6] and a number of initiatives and scientific studies are carried out to strengthen the One Health approach, monitor the development of resistances, foster adequate competencies and to preserve existing treatment options [7]. ARena was seen as a constant reminder of a rational use of antibiotics Physicians stated they felt empowered in their choice of treatment in case uncertainties occurred. Another positive contribution was seen in a frequent participation in QCs

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Discussion

Conclusion