Evidence map›Paper›PMID 39425170›Full record

Trial reportTrials2024

Implementation of a tailored multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for urinary tract infections in frail older adults (ImpresU) in four European countries: a process evaluation alongside a pragmatic cluster randomized controlled trial.

Esther A R Hartman, Wim G Groen, Silje Rebekka Heltveit-Olsen, Morten Lindbæk, Sigurd Høye, Sara Sofia Lithén, Pär-Daniel Sundvall, Sofia Sundvall, Egill Snaebjörnsson Arnljots, Ronny Gunnarsson and 7 more

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Trials, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03970356 (The Improving Rational Prescribing for Urinary Tract Infections in Frail Elderly), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing 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.

NCT03970356 nacompletednot on this map

The Improving Rational Prescribing for Urinary Tract Infections in Frail Elderly (ImpresU) Project - Work Package 2 (WP2): a Cluster Randomised Multifaceted Antibiotic Stewardship Intervention Study

TypeinterventionalSponsorCees HertoghRan2019 to 2021Enrolled1,146ConditionsUrinary Tract InfectionsArmsantibiotic stewardship intervention
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Review
  3. Article
  4. 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

17 authors.

Esther A R HartmanDepartment of Medicine for Older People, Amsterdam, UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands. e.hartman1@amsterdamumc.nl.ORCID http://orcid.org/0000-0003-0907-2476
Wim G GroenDepartment of Medicine for Older People, Amsterdam, UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
Silje Rebekka Heltveit-OlsenThe Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Blindern, Oslo, P.O. Box 1130, 0318, Norway.ORCID http://orcid.org/0000-0002-8645-5836
Morten LindbækThe Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Blindern, Oslo, P.O. Box 1130, 0318, Norway.
Sigurd HøyeThe Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Blindern, Oslo, P.O. Box 1130, 0318, Norway.
Sara Sofia LithénThe Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Blindern, Oslo, P.O. Box 1130, 0318, Norway.
Pär-Daniel SundvallGeneral Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Box 454, 405 30, Sweden.
Sofia SundvallResearch, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, FoUUI-Centrum Södra Älvsborg, Sven Eriksonsplatsen 4, SE-503 38, Borås, Sweden.
Egill Snaebjörnsson ArnljotsGeneral Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Box 454, 405 30, Sweden.
Ronny GunnarssonGeneral Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Box 454, 405 30, Sweden.
Anna KowalczykCentre for Family and Community Medicine, The Faculty of Health Sciences, The Medical University of Lodz, Lodz, 90-419, Poland.
Maciej Godycki-CwirkoCentre for Family and Community Medicine, The Faculty of Health Sciences, The Medical University of Lodz, Lodz, 90-419, Poland.
Alma C van de PolJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Utrecht, 3584 CG, The Netherlands.
Tamara N PlatteelJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Utrecht, 3584 CG, The Netherlands.
Annelie A MonnierDepartment of Medicine for Older People, Amsterdam, UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.ORCID http://orcid.org/0000-0002-5844-286X
Theo J M VerheijJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Utrecht, 3584 CG, The Netherlands.
Cees M P M HertoghDepartment of Medicine for Older People, Amsterdam, UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWe previously performed a pragmatic cluster randomized controlled trial (RCT) in general practices and older adult care organizations in Poland, the Netherlands, Norway, and Sweden. We found that a multifaceted antibiotic stewardship intervention (ASI) substantially reduced antibiotic use for suspected urinary tract infections (UTIs) in frail older adults compared with usual care. We aimed to evaluate the implementation process of the ASI to provide recommendations for clinical practice.

methodsWe conducted a process evaluation alongside the cluster RCT. The ASI consisted of a decision-tool and a toolbox, which were implemented using a participatory-action-research (PAR) approach with sessions for education and evaluation. We documented the implementation process of the intervention and administered a questionnaire to health care professionals (HCPs) from participating organizations in the intervention and usual care clusters. We evaluated the multiple components of the intervention and its implementation following a structured framework.

resultsThe questionnaire was completed by 254 HCPs from the 38 participating clusters. All components were largely delivered according to plan and evaluated as useful. The decision-tool and toolbox materials were reported to facilitate decision-making on UTIs. Regarding the PAR approach, educational sessions focusing on the distinction between UTIs and asymptomatic bacteriuria were held in all 19 intervention clusters. In 17 out of these 19 clusters, evaluation sessions took place, which were reported to help remind HCPs to implement the ASI. During both sessions, HCPs valued the reflection that took place and the resulting awareness of their behavior. It allowed them to explore implementation barriers and to tailor their local implementation process to overcome these. For example, HCPs organized extra educational sessions or revised local policies to incorporate the use of the decision-tool. Various HCPs took key roles in implementation. Staff changes and the COVID-19 pandemic were important contextual barriers.

conclusionsWe found each component of the multifaceted ASI and its implementation to have added value in the process to improve antibiotic prescribing for suspected UTIs in a heterogeneous older adult care setting. We recommend using a multifaceted, multidisciplinary approach that enables HCPs to reflect on their current practice and accordingly tailor local implementation.

trial registrationClinicalTrials.gov NCT03970356. Registered on May 31, 2019.

Indexed as

Anti-Bacterial AgentsAntimicrobial StewardshipFrail ElderlyPractice Patterns, Physicians'Urinary Tract InfectionsAgedAged, 80 and overEuropeFemaleHumansMaleSurveys and QuestionnairesAnti-Bacterial AgentsAntibiotic stewardshipOlder adultsProcess evaluationUrinary tract infections

Identifiers

PMID39425170
PMCPMC11488242

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

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.