Article type
Year
Abstract
Background: Cochrane Reviews on antimicrobial prescribing in outpatient and inpatient settings have identified different effect sizes and levels of success for different types of interventions. Nonetheless, more clarity is needed on how these interventions can be used effectively under different circumstances and for different professional groups.
Objectives: The IMPACT realist review used a broad range of literature to develop theoretically-informed explanations about how the process of antimicrobial prescribing works for doctors-in-training. This review will draw conclusions on how and why specific interventions might produce particular effects, taking into account the role of the context in which antimicrobial prescribing decisions are negotiated.
Methods: A realist review is an interpretive, theory-driven approach to evidence synthesis. For the IMPACT review, clearly bounded searches of electronic databases were supplemented by citation tracking and grey literature searches. Following current quality standards for realist reviews, the resulting articles (N =115) were screened and analysed to draw theoretically-driven explanations of how antimicrobial prescribing works in practice. A programme theory was iteratively developed and refined with input from our stakeholder group.
Results: Few interventions are designed and implemented in a way that pays adequate attention to the influence of context and the ways this changes during clinical training. The social, organisational and professional environment in which trainees operate has a significant influence on the way antimicrobial prescribing interventions are perceived and adopted. The dynamics between junior and senior members of staff have a powerful effect on the antimicrobial prescribing process and the outcomes achieved by different interventions.
Conclusions: By using a realist review to make sense of the literature on antimicrobial prescribing for doctors-in-training we were able to draw transferable lessons on how and why interventions can be designed and implemented in specific ways for different contexts to achieve desired outcomes.
Objectives: The IMPACT realist review used a broad range of literature to develop theoretically-informed explanations about how the process of antimicrobial prescribing works for doctors-in-training. This review will draw conclusions on how and why specific interventions might produce particular effects, taking into account the role of the context in which antimicrobial prescribing decisions are negotiated.
Methods: A realist review is an interpretive, theory-driven approach to evidence synthesis. For the IMPACT review, clearly bounded searches of electronic databases were supplemented by citation tracking and grey literature searches. Following current quality standards for realist reviews, the resulting articles (N =115) were screened and analysed to draw theoretically-driven explanations of how antimicrobial prescribing works in practice. A programme theory was iteratively developed and refined with input from our stakeholder group.
Results: Few interventions are designed and implemented in a way that pays adequate attention to the influence of context and the ways this changes during clinical training. The social, organisational and professional environment in which trainees operate has a significant influence on the way antimicrobial prescribing interventions are perceived and adopted. The dynamics between junior and senior members of staff have a powerful effect on the antimicrobial prescribing process and the outcomes achieved by different interventions.
Conclusions: By using a realist review to make sense of the literature on antimicrobial prescribing for doctors-in-training we were able to draw transferable lessons on how and why interventions can be designed and implemented in specific ways for different contexts to achieve desired outcomes.