Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

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

Regina Poss-Doering
* ORCID logo ,
Lukas Kühn
,
Martina Kamradt
,
Anna Stürmlinger
,
Katharina Glassen
,
Edith Andres
,
Petra Kaufmann-Kolle
,
Veit Wambach
,
Lutz Bader
,
Joachim Szecsenyi
,
Michel Wensing
Version 1 : Received: 3 November 2020 / Approved: 5 November 2020 / Online: 5 November 2020 (18:11:28 CET)

A peer-reviewed article of this Preprint also exists.

Poss-Doering, R.; Kühn, L.; Kamradt, M.; Stürmlinger, A.; Glassen, K.; Andres, E.; Kaufmann-Kolle, P.; Wambach, V.; Bader, L.; Szecsenyi, J.; Wensing, M. Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena. Antibiotics 2020, 9, 878. Poss-Doering, R.; Kühn, L.; Kamradt, M.; Stürmlinger, A.; Glassen, K.; Andres, E.; Kaufmann-Kolle, P.; Wambach, V.; Bader, L.; Szecsenyi, J.; Wensing, M. Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena. Antibiotics 2020, 9, 878.

Abstract

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.

Keywords

appropriate antibiotics use; primary care; quality improvement; mixed-methods

Subject

Medicine and Pharmacology, Immunology and Allergy

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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