Evidence map›Paper›PMID 33334829›Full record

ReviewBMJ open2020

Optimising antimicrobial stewardship interventions in English primary care: a behavioural analysis of qualitative and intervention studies.

Aleksandra J Borek, Marta Wanat, Louise Atkins, Anna Sallis, Diane Ashiru-Oredope, Elizabeth Beech, Christopher C Butler, Tim Chadborn, Susan Hopkins, Leah Jones and 5 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.

0numbers the graph read from it
0cells of the map it votes in
16citing 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

16 citing papers in PubMed.

  1. Systematic review of implementing stewardship activities to promote appropriate antimicrobial use.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026
    Review
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  9. A mixed-methods needs assessment for an antimicrobial stewardship curriculum in pediatrics.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024
    Article
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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

15 authors.

Aleksandra J BorekNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK aleksandra.borek@phc.ox.ac.uk.ORCID 0000-0001-6029-5291
Marta WanatNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.
Louise AtkinsCentre for Behaviour Change, University College London, London, UK.
Anna SallisBehavioural Insights, Public Health England, London, UK.
Diane Ashiru-OredopeAntimicrobial Resistance and Stewardship and Healthcare Associated Infections (HCAI), Public Health England, London, UK.
Elizabeth BeechNHS England and NHS Improvement, London, UK.
Christopher C ButlerNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.ORCID 0000-0002-0102-3453
Tim ChadbornBehavioural Insights, Public Health England, London, UK.
Susan HopkinsAntimicrobial Resistance and Stewardship and Healthcare Associated Infections (HCAI), Public Health England, London, UK.ORCID 0000-0001-5179-5702
Leah JonesPrimary Care and Interventions Unit, Public Health England, Gloucester, UK.
Cliodna A M McNultyPrimary Care and Interventions Unit, Public Health England, Gloucester, UK.
Nia RobertsBodleian Health Care Libraries, University of Oxford, Oxford, UK.
Karen ShawAntimicrobial Resistance and Stewardship and Healthcare Associated Infections (HCAI), Public Health England, London, UK.
Esther TabornNHS England and NHS Improvement, London, UK.
Sarah Tonkin-CrineNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.ORCID 0000-0003-4470-1151

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveWhile various interventions have helped reduce antibiotic prescribing, further gains can be made. This study aimed to identify ways to optimise antimicrobial stewardship (AMS) interventions by assessing the extent to which important influences on antibiotic prescribing are addressed (or not) by behavioural content of AMS interventions. SETTINGS: English primary care.

interventionsAMS interventions targeting healthcare professionals' antibiotic prescribing for respiratory tract infections.

methodsWe conducted two rapid reviews. The first included qualitative studies with healthcare professionals on self-reported influences on antibiotic prescribing. The influences were inductively coded and categorised using the Theoretical Domains Framework (TDF). Prespecified criteria were used to identify key TDF domains. The second review included studies of AMS interventions. Data on effectiveness were extracted. Components of effective interventions were extracted and coded using the TDF, Behaviour Change Wheel and Behaviour Change Techniques (BCTs) taxonomy. Using prespecified matrices, we assessed the extent to which BCTs and intervention functions addressed the key TDF domains of influences on prescribing.

resultsWe identified 13 qualitative studies, 41 types of influences on antibiotic prescribing and 6 key TDF domains of influences: 'beliefs about consequences', 'social influences', 'skills', 'environmental context and resources', 'intentions' and 'emotions'. We identified 17 research-tested AMS interventions; nine of them effective and four nationally implemented. Interventions addressed all six key TDF domains of influences. Four of these six key TDF domains were addressed by 50%-67% BCTs that were theoretically congruent with these domains, whereas TDF domain

conclusionsFurther improvement of antibiotic prescribing could be facilitated by: (1) national implementation of effective research-tested AMS interventions (eg, electronic decision support tools, training in interactive use of leaflets, point-of-care testing); (2) targeting important, less-addressed TDF domains (eg,

Indexed as

Antimicrobial StewardshipPrimary Health CareBehavior TherapyHealth PersonnelHumansQualitative Researchprimary carepublic healthqualitative researchrespiratory infections

Identifiers

PMID33334829
PMCPMC7747536

What OpenQuestion holds

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Registered trials

None linked

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.