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

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 878
Author(s):  
Regina Poss-Doering ◽  
Lukas Kühn ◽  
Martina Kamradt ◽  
Anna Stürmlinger ◽  
Katharina Glassen ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Randomized Trial ◽  
Process Evaluation ◽  
Complex Intervention ◽  
Intervention Program ◽  
Cluster Randomized Trial ◽  
Prescribing Patterns ◽  
Audit And Feedback ◽  
Medical Assistants ◽  
Cluster Randomized

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.

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

2020 ◽  
Author(s):  
Regina Poss-Doering ◽  
Lukas Kühn ◽  
Martina Kamradt ◽  
Anna Stürmlinger ◽  
Katharina Glassen ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Randomized Trial ◽  
Process Evaluation ◽  
Complex Intervention ◽  
Cluster Randomized Trial ◽  
Prescribing Patterns ◽  
Audit And Feedback ◽  
Appropriate Use ◽  
Medical Assistants ◽  
Cluster Randomized

The cluster randomized trial ARena (Sustainable reduction of antibiotic-induced antimicrobial resistance, 2017-2020) promoted the appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation aimed to provide insights into determinants of practice and explored factors associated with antibiotic prescribing patterns. In a nested mixed-methods approach, a three-waves survey used study-specific questionnaires for participating physicians and medical assistants to assess 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 aspects regarding the acceptance of the program components for daily practice and the perceived sustainability of intervention component effects. The intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for the educational components: feedback reports, background information, e-learning modules, and disease specific quality circles. Participation in PCNs was seen as motivational factor for guideline-oriented patient care and the adoption of new routines Future approaches to fostering appropriate use of antibiotics by targeting health literacy competencies and clinician’s therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.

Reducing Physical Aggression in High School Students in KwaZulu-Natal: A Cluster Randomized Trial

2020 ◽  
Vol 35 (6) ◽  
pp. 861-884
Author(s):  
Myra Taylor ◽  
Benn Sartorius ◽  
Saloshni Naidoo ◽  
Hein de Vries
Keyword(s):  
High School Students ◽  
Randomized Trial ◽  
Youth Violence ◽  
Intervention Program ◽  
Physical Violence ◽  
Cluster Randomized Trial ◽  
School Students ◽  
Analytical Technique ◽  
Cluster Randomized ◽  
The Impact

Youth violence is of public health and social concern. A South African cluster randomized trial (434 grade 10 students, 16 schools), used the Integrated Model for Behavior Change conceptual framework to implement a 20 module classroom-based intervention program. The study contributes to the literature and used a strong analytical technique since mixed effects linear regression assessed the impact of the intervention on physical violence endpoints and other socioeconomic confounders/factors. The intervention reduced students' experiencing physical violence compared to controls and social pressure for this, yet no differences were found for hitting others. Our results support findings that school programs against violence can reduce students' experience of physical violence, but translation of these findings to reduce the actual hitting of others may need further approaches and/or more time.

scholarly journals Implementation of French Recommendations for the Prevention and the Treatment of Hospital-acquired Pneumonia: A Cluster-randomized Trial

2020 ◽  
Author(s):  
Antoine Roquilly ◽  
Gérald Chanques ◽  
Sigismond Lasocki ◽  
Arnaud Foucrier ◽  
Brice Fermier ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Intervention Group ◽  
Cluster Randomized Trial ◽  
Baseline Period ◽  
Audit And Feedback ◽  
Control Group ◽  
Icu Stay ◽  
Hospital Acquired Pneumonia ◽  
Cluster Randomized ◽  
Hospital Acquired

Abstract Background We determined whether an audit on the adherence to guidelines for hospital-acquired pneumonia (HAP) can improve the outcomes of patients in intensive care units (ICUs). Methods This study was conducted at 35 ICUs in 30 hospitals. We included consecutive, adult patients hospitalized in ICUs for 3 days or more. After a 3-month baseline period followed by the dissemination of recommendations, an audit on the compliance to recommendations (audit period) was followed by a 3-month cluster-randomized trial. We randomly assigned ICUs to either receive audit and feedback (intervention group) or participate in a national registry (control group). The primary outcome was the duration of ICU stay. Results Among 1856 patients enrolled, 602, 669, and 585 were recruited in the baseline, audit, and intervention periods, respectively. The composite measures of compliance were 47% (interquartile range [IQR], 38–56%) in the intervention group and 42% (IQR, 25–53%) in the control group (P = .001). As compared to the baseline period, the ICU lengths of stay were reduced by 3.2 days in the intervention period (P = .07) and by 2.8 days in the control period (P = .02). The durations of ICU stay were 7 days (IQR, 5–14 days) in the control group and 9 days (IQR, 5–20 days) in the intervention group (P = .10). After adjustment for unbalanced baseline characteristics, the hazard ratio for being discharged alive from the ICU in the control group was 1.17 (95% confidence interval, .69–2.01; P = .10). Conclusions The publication of French guidelines for HAP was associated with a reduction of the ICU length of stay. However, the realization of an audit to improve their application did not further improve outcomes. Clinical Trials Registration NCT03348579.

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