Evidence map›Paper›PMID 31753887›Full record

ArticleBMJ open2019

Multifaceted intervention to Reduce Antimicrobial Prescribing in Care Homes: a process evaluation of a UK-based non-randomised feasibility study.

Rachel Potter, Anne Campbell, David R Ellard, Catherine Shaw, Evie Gardner, Ashley Agus, Dermot O'Reilly, Martin Underwood, Mark Loeb, Bob Stafford and 2 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Trial
  2. Review
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  8. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Rachel PotterClinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
Anne CampbellHealth Protection Research Unit, Imperial College London, London, UK.
David R EllardClinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK D.R.Ellard@warwick.ac.uk.ORCID 0000-0002-2992-048X
Catherine ShawSchool of Pharmacy, Queen's University Belfast, Belfast, UK.
Evie GardnerNorthern Ireland Clinical Trials Unit, Royal Hospitals, Belfast, UK.
Ashley AgusNorthern Ireland Clinical Trials Unit, Royal Hospitals, Belfast, UK.ORCID 0000-0001-9839-6282
Dermot O'ReillyCentre for Public Health, Queen's University Belfast, Belfast, UK.
Martin UnderwoodClinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
Mark LoebDepartment of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
Bob StaffordOrchard Care Homes, Harrogate, UK.
Michael TunneySchool of Pharmacy, Queen's University Belfast, Belfast, UK.
Carmel HughesSchool of Pharmacy, Queen's University Belfast, Belfast, UK.

Funding

Department of Health HS&DR/13/97/12
6 · The paper itself

Abstract

objectivesTo explore the facilitators and obstacles to the development and implementation of the Reduce Antimicrobial Prescribing in Care Homes intervention.

designWe used a mixed-methods approach. We conducted focus groups with care home staff and relatives of residents, and interviews with general practitioners (GPs) and home managers, completed observational visits and collected demographic data, training attendance records and data on the use of a decision-making algorithm. We used normalisation process theory to inform topic guides and interpretation of the data.

settingSix care homes, three in Northern Ireland and three in the West Midlands, England.

interventionA decision-making algorithm for urinary tract, respiratory tract and skin and soft-tissue infections, plus small group interactive training for care home staff.

resultsWe ran 21 training sessions across the six homes and trained 35/42 (83%) of nurses and 101/219 (46%) of all care staff. Care home staff reported using the decision-making algorithm 81 times. Postimplementation, staff reported being more knowledgeable about antimicrobial resistance but were unsure if the intervention would change how GPs prescribed antimicrobials. The pressures of everyday work in some homes meant that engagement was challenging at times. Staff felt that some of the symptoms included in decision-making algorithm, despite being evidence based, were not easy to detect in residents with dementia or urinary incontinence. Some staff did not use the decision-making algorithm, noting that their own knowledge of the resident was more important.

conclusionWe delivered a training package to a substantial number of key staff in care homes. A decision-making algorithm for common infections in care homes empowered staff but was challenging to operationalise at times. A future study should consider the findings from the process evaluation to help ensure the successful implementation on a larger scale.

Indexed as

Health Knowledge, Attitudes, PracticeAgedAged, 80 and overAnti-Infective AgentsClinical Decision-MakingDrug PrescriptionsFeasibility StudiesFemaleFocus GroupsHomes for the AgedHumansInterviews as TopicMaleMiddle AgedNursing HomesQualitative ResearchAnti-Infective Agentsantimicrobial prescribingcare homeselderly careprocess evaluationQUALITATIVE RESEARCHurinary tract infections

Identifiers

PMID31753887
PMCPMC6887004

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.