A mixed-methods study highlights the importance that knowledge, infrastructure, institutional support, and relationships among clinical teams play in effective antibiotic stewardship, researchers reported this week in Clinical Infectious Diseases.
For the study, a team led by researchers from the University of Utah School of Medicine conducted surveys, document and data analysis, and semi-structured interviews with antibiotic stewardship and clinical stakeholders at seven hospitals in Michigan and the Mountain West that were categorized as high-, medium-, or low-performing on antibiotic overuse at discharge. The aim was to identify the organizational characteristics that differentiate hospitals with low versus high antibiotic overuse.
The analysis of surveys, documents, and interviews with 90 stakeholders across the hospitals (31 hospitalists, 33 clinical pharmacists, 14 stewardship leaders, and 12 hospital leaders) identified four contextual factors that varied between hospitals with low versus high antibiotic overuse: robust knowledge of and access to antibiotic stewardship guidance, high-quality clinical pharmacist-physician relationships, tools and infrastructure to support stewardship, and highly engaged infectious diseases physicians who advocated for stewardship principles.
Relationships and institutional support
The study authors say that while many efforts to improve antibiotic prescribing focus on the behavior of individual physicians, these findings suggest that such a strategy is likely insufficient.
"Relationships and the roles that stewardship stakeholders play also matter," they wrote. "Efforts to improve how decisions are made about antibiotics require attention to the knowledge, interactions between stakeholders, and systems in place to support stakeholders."
Based on the findings, the authors say that hospitals can encourage high performance on antibiotic prescribing by maintaining updated and accurate clinical guidelines, finding ways to improve face-to-face interactions between clinical pharmacists and physicians, engaging end-users in the design and implementation of stewardship tools, and providing institutional support for antibiotic stewardship programs.
Efforts to improve how decisions are made about antibiotics require attention to the knowledge, interactions between stakeholders, and systems in place to support stakeholders.