Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the...

Area of Science:

• Health Services Research
• Antimicrobial Stewardship
• Implementation Science

Background:

• Antimicrobial resistance is a significant global health threat.
• Appropriate antibiotic prescribing in primary care is crucial for combating resistance.
• The ARena trial aimed to reduce antibiotic-induced resistance through interventions in German primary care networks (PCNs).

Purpose of the Study:

• To evaluate the uptake and impact of a complex intervention program designed to promote appropriate antibiotic use in primary care.
• To identify factors influencing the adoption and sustainability of antibiotic stewardship practices.
• To explore the potential for implementing these interventions into routine healthcare.

Main Methods:

• A cluster randomized trial (ARena) involving PCNs in Germany.
• A nested mixed-methods approach including three-wave surveys for physicians and medical assistants.
• Online questionnaires for stakeholders and semi-structured interviews with physicians, medical assistants, and stakeholders.

Main Results:

• Intervention components were perceived as easily integrable into practice routines.
• Educational components, including feedback reports, information, e-learning, and quality circles (QCs), demonstrated the highest uptake.
• Participation in PCNs was a key motivator for guideline-oriented care and adopting new prescribing routines.

Conclusions:

• The ARena intervention components are feasible for integration into primary care settings.
• Combining evidence-based information, audit and feedback, and quality circles is recommended for future antibiotic stewardship initiatives.
• Targeting health literacy and clinical decision-making can further enhance appropriate antibiotic use.