Improving antibiotic use through behaviour change: a systematic review of interventions evaluated in low- and middle-income countries.
Improving antibiotic use through behaviour change: a systematic review of interventions evaluated in low- and middle-income countries.
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DOI：
10.1093/heapol/czab021
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发表时间：
2021-06-03
影响因子：
3.2
通讯作者：
Wiseman V
中科院分区：
文献类型：
--
作者：
Cuevas C;Batura N;Wulandari LPL;Khan M;Wiseman V
抗生素耐药性（ABR）已被最高政策论坛确定为对全球健康的严重威胁。 ABR 的一个主要原因是患者和医疗保健提供者不恰当地使用抗生素。尽管世界各国已承诺制定和实施国家行动计划来应对 ABR，但在中低收入国家 (LMIC) 中，关于解决抗生素不当使用问题的有效行为改变干预措施的证据还存在很大差距，这些国家的 ABR 正在以惊人的速度增长。我们进行了系统评价，以综合关于行为改变干预措施的有效性和成本效益的证据，以减少中低收入国家不当使用抗生素。使用一组预定义的搜索词和排除标准搜索了三个数据库。搜索找到了 43 篇相关文章。使用行为改变轮框架对结果进行叙述性综合，以对干预成分进行分类。大多数审查的研究都是在撒哈拉以南非洲或东亚和太平洋地区的中低收入或低收入国家进行的。 24 篇文章评估了 12 个月或更短时间内的多方面干预措施。尽管抗生素在社区广泛使用，但干预措施主要在公共卫生机构实施，针对的是医生、护士和其他专职医疗人员等卫生专业人员。尽管对服务提供者的教育是影响抗生素使用最广泛使用的策略，但事实证明，与培训或其他促进行为的扶持和支持措施结合使用时，它是最有效的。六篇文章对干预措施的成本进行了评估，发现住院和门诊的成本有所降低，一篇文章发现基于培训和指南实施的干预措施具有很高的成本效益。然而，进行经济评估的文章数量较少，这凸显了需要更频繁地进行此类分析，以支持在资源有限的环境中确定优先事项。
Antibiotic resistance (ABR) has been identified as a critical threat to global health at the highest policy fora. A leading cause of ABR is the inappropriate use of antibiotics by both patients and healthcare providers. Although countries around the world have committed to developing and implementing national action plans to tackle ABR, there is a considerable gap in evidence about effective behaviour change interventions addressing inappropriate use of antibiotics in low- and middle-income countries (LMICs), where ABR is growing at an alarming rate. We conducted a systematic review to synthesize evidence about the effectiveness and cost-effectiveness of behaviour change interventions to reduce inappropriate use of antibiotics in LMICs. Three databases were searched using a set of predefined search terms and exclusion criteria. The search identified 43 relevant articles. A narrative synthesis of results was conducted using the Behaviour Change Wheel framework to categorize intervention components. The majority of the reviewed studies were set in lower-middle-income or low-income countries located in Sub-Saharan Africa or East Asia and the Pacific. Twenty-four articles evaluated multi-faceted interventions over a period of 12 months or less. Despite the widespread use of antibiotics in the community, interventions were primarily implemented in public health facilities, targeting health professionals such as doctors, nurses, and other allied medical staff. Although education for providers was the most widely used strategy for influencing antibiotic use, it was shown to be most effective when used in conjunction with training or other enabling and supportive measures to nudge behaviour. Six articles included an evaluation of costs of interventions and found a reduction in costs in inpatient and outpatient settings, and one article found a training and guidelines implementation-based intervention to be highly cost-effective. However, the small number of articles conducting an economic evaluation highlights the need for such analyses to be conducted more frequently to support priority setting in resource-constrained environments.
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