Evidence map›Paper›PMID 32646382›Full record

SynthesisBMC geriatrics2020

Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review.

Elise Crayton, Michelle Richardson, Chris Fuller, Catherine Smith, Sunny Liu, Gillian Forbes, Niall Anderson, Laura Shallcross, Susan Michie, Andrew Hayward and 1 more

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC geriatrics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 4 pooled it
8.6field-weighted citation impact, top 2% of its field
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

19 citing papers in PubMed, 4 syntheses or guidelines pooled it, 51 citations in OpenAlex.

  1. Pooled it
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  4. Pooled it
  5. Article
  6. Article
  7. Review
  8. Institutional spillover effects of antimicrobial use on antimicrobial resistance andAntimicrobial stewardship & healthcare epidemiology : ASHE · 2026
    Article
  9. Article
  10. Article
  11. Article
  12. Article
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  14. Review
  15. Feasibility of a Nursing Home Antibiotic Stewardship Intervention.Journal of the American Medical Directors Association · 2022
    Article
  16. Article
  17. Article
  18. Article
  19. Article
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

11 authors at 2 institutions in 1 country.

Elise CraytonDepartment of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. e.crayton@ucl.ac.uk.ORCID 0000-0002-9266-1302
Michelle RichardsonInstitute of Education (IOE), University College London, London, WC1H 0NS, UK.
Chris FullerInstitute of Health Informatics, University College London, London, NW1 2DA, UK.
Catherine SmithInstitute of Health Informatics, University College London, London, NW1 2DA, UK.
Sunny LiuDepartment of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
Gillian ForbesDepartment of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
Niall AndersonDepartment of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
Laura ShallcrossInstitute of Health Informatics, University College London, London, NW1 2DA, UK.
Susan MichieDepartment of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
Andrew HaywardInstitute of Epidemiology & Health, University College London, London, WC1E 7HB, UK.
Fabiana LorencattoDepartment of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
University College London · GBNational Institute for Health Research · GB

Funding

Economic and Social Research Council ES/P008321/1
6 · The paper itself

Abstract

backgroundOveruse of antibiotics has contributed to antimicrobial resistance; a growing public health threat. In long-term care facilities, levels of inappropriate prescribing are as high as 75%. Numerous interventions targeting long-term care facilities' antimicrobial stewardship have been reported with varying, and largely unexplained, effects. Therefore, this review aimed to apply behavioural science frameworks to specify the component behaviour change techniques of stewardship interventions in long-term care facilities and identify those components associated with improved outcomes.

methodA systematic review (CRD42018103803) was conducted through electronic database searches. Two behavioural science frameworks, the Behaviour Change Wheel and Behaviour Change Technique Taxonomy were used to classify intervention descriptions into intervention types and component behaviour change techniques used. Study design and outcome heterogeneity prevented meta-analysis and meta-regression. Interventions were categorised as 'very promising' (all outcomes statistically significant), 'quite promising' (some outcomes statistically significant), or 'not promising' (no outcomes statistically significant). 'Promise ratios' (PR) were calculated for identified intervention types and behaviour change techniques by dividing the number of (very or quite) promising interventions featuring the intervention type or behaviour change technique by the number of interventions featuring the intervention type or behaviour change technique that were not promising. Promising intervention types and behaviour change techniques were defined as those with a PR ≥ 2.

resultsTwenty studies (of19 interventions) were included. Seven interventions (37%) were 'very promising', eight 'quite promising' (42%) and four 'not promising' (21%). Most promising intervention types were 'persuasion' (n = 12; promise ratio (PR) = 5.0), 'enablement' (n = 16; PR = 4.33) and 'education' (n = 19; PR = 3.75). Most promising behaviour change techniques were 'feedback on behaviour' (n = 9; PR = 8.0) and 'restructuring the social environment' (e.g. staff role changes; n = 8; PR = 7.0).

conclusionSystematic identification of the active ingredients of antimicrobial stewardship in long-term care facilities was facilitated through the application of behavioural science frameworks. Incorporating environmental restructuring and performance feedback may be promising intervention strategies for antimicrobial stewardship interventions within long-term care facilities.

Indexed as

Anti-Bacterial AgentsLong-Term CareBehavior TherapyHumansInappropriate PrescribingSkilled Nursing FacilitiesAnti-Bacterial AgentsAntimicrobial stewardshipBehavioural sciencesNursing homesSystematic review

Identifiers

PMID32646382
PMCPMC7350746
OpenAlexW3041074145

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

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 Socratic graph.