Implementation of an antimicrobial stewardship program in the Australian private hospital system: qualitative study of attitudes to antimicrobial resistance and antimicrobial stewardship

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Antimicrobial Stewardship (AMS) is a key method to tackle antimicrobial resistance (AMR). In Australia, private hospitals have a higher rate of inappropriate prescribing and non-compliance with antimicrobial guidelines, yet this phenomenon is poorly described. Private hospitals make up 49% of hospitals in Australia, making it vital to understand AMS in this setting.

Methods

This study aimed to explore capabilities, opportunities and motivations for AMR and AMS with stakeholders at an Australian private hospital, and identify barriers and enablers 5 years post-implementation of an AMS program comparing with pre-implementation findings. A mixed-methods study was performed, involving three focus groups with stakeholders. All doctors, nurses and pharmacists at the hospital were invited to complete a survey on their experiences with and awareness of AMR, AMS and antimicrobial prescribing.

Results

Thirteen staff took part in the focus groups, 100 staff responded to the survey. Staff understood the importance of the AMS program, but active engagement was low. Staff felt more thorough feedback and monitoring could improve prescribing behaviour, but acknowledged difficulty in private hospitals in changing habits of staff who valued autonomy in making prescribing decisions. Half of respondents felt the current AMS restrictions should continue. Executive engagement may be needed to drive system changes across a complex network.

Conclusion

AMS awareness increased post-implementation, but staff remained sceptical of its benefits. Engagement and education of medical consultants regarding local benefits of AMS must improve. Enhanced understanding of feedback provision, methods for engagement, and advocacy from leadership will ensure success and longevity for the program.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08938-8.

Related collections

Most cited references 41

Record: found
Abstract: found
Article: found

Is Open Access

The behaviour change wheel: A new method for characterising and designing behaviour change interventions

Susan Michie, Maartje M. van Stralen, Robert H. West (2012)

Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.

0 comments Cited 2898 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

Susan Michie, Michelle Richardson, Marie Johnston … (2014)

CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity. The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions. In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed. This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above. "BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.

0 comments Cited 1849 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Health promotion by social cognitive means.

Albert Bandura (2004)

This article examines health promotion and disease prevention from the perspective of social cognitive theory. This theory posits a multifaceted causal structure in which self-efficacy beliefs operate together with goals, outcome expectations, and perceived environmental impediments and facilitators in the regulation of human motivation, behavior, and well-being. Belief in one's efficacy to exercise control is a common pathway through which psychosocial influences affect health functioning. This core belief affects each of the basic processes of personal change--whether people even consider changing their health habits, whether they mobilize the motivation and perseverance needed to succeed should they do so, their ability to recover from setbacks and relapses, and how well they maintain the habit changes they have achieved. Human health is a social matter, not just an individual one. A comprehensive approach to health promotion also requires changing the practices of social systems that have widespread effects on human health.

0 comments Cited 768 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Trisha Peel: trisha.peel@monash.edu

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 20 December 2022

Publication date PMC-release: 20 December 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 1554

Affiliations

[1 ]GRID grid.1002.3, ISNI 0000 0004 1936 7857, Health and Social Care Unit, School of Public Health and Preventive Medicine, , Monash University, ; Melbourne, VIC Australia

[2 ]GRID grid.1002.3, ISNI 0000 0004 1936 7857, Department of Epidemiology and Preventive Medicine, , Monash University, ; Melbourne, VIC Australia

[3 ]GRID grid.1002.3, ISNI 0000 0004 1936 7857, Department of Infectious Diseases, Alfred Hospital and Central Clinical School, , Monash University, ; Level 2, 85 Commercial Road, VIC Melbourne, 3004 Australia

[4 ]GRID grid.414539.e, ISNI 0000 0001 0459 5396, Epworth HealthCare, ; Melbourne, VIC Australia

[5 ]GRID grid.1055.1, ISNI 0000000403978434, Department of Infectious Diseases, , Peter MacCallum Cancer Centre, ; Melbourne, Australia

[6 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Sir Peter MacCallum Department of Oncology, , University of Melbourne, ; Melbourne, VIC Australia

[7 ]Slade Pharmacy, Melbourne, VIC Australia

[8 ]GRID grid.1003.2, ISNI 0000 0000 9320 7537, UQCCR, Faculty of Medicine, , The University of Queensland, ; Brisbane, QLD Australia

Article

Publisher ID: 8938

DOI: 10.1186/s12913-022-08938-8

PMC ID: 9764684

PubMed ID: 36536350

SO-VID: c383e75a-c707-458a-b900-f0d77a8b8009

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 22 November 2021

Date accepted : 6 December 2022

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: antimicrobial stewardship,program evaluation,private healthcare facility

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: antimicrobial stewardship, program evaluation, private healthcare facility

Implementation of an antimicrobial stewardship program in the Australian private hospital system: qualitative study of attitudes to antimicrobial resistance and antimicrobial stewardship

Read this article at

Abstract

Background

Methods

Results

Conclusion

Supplementary Information

Related collections

Tobacco Prevention & Cessation

Most cited references 41

The behaviour change wheel: A new method for characterising and designing behaviour change interventions

The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

Health promotion by social cognitive means.

Author and article information

Contributors

Journal

Affiliations

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 143

Cited by 3

Most referenced authors 616