兰德-Antimicrobial-stewardship_-The-effectiveness-of-educational-interventions-to-change-risk_211页_1mb

Antimicrobial Stewardship: Educational Interventions to Change Risk-Related Behaviours

Core Content

This document presents a systematic review of educational interventions aimed at changing the public's risk-related behaviours regarding antimicrobial use, with a focus on antibiotic knowledge and appropriate use, as well as infection prevention and the reduction of antimicrobial resistance (AMR). The review was conducted by RAND Europe on behalf of the National Institute for Health and Care Excellence (NICE) to inform the development of public health guidelines aimed at delaying AMR.

The review included 60 studies published from 2001 onwards, divided into two main research questions:

1. Which educational interventions are effective and cost-effective in changing the public's behaviour to ensure they only ask for antimicrobials when appropriate and use them correctly?
2. Which educational interventions are effective and cost-effective in changing the public's behaviour to prevent infection and reduce the spread of AMR?

The studies were categorized by setting and intervention type, and the quality of evidence was assessed using NICE methodology. Most studies were rated as poor quality (-), with only a few rated as moderate quality (+).

Key Findings

Research Question 1: Antibiotic Knowledge and Behaviour

• Pharmacist-led interventions: Weak evidence suggests that pharmacist-led verbal education, combined with written information, improves adherence and knowledge of appropriate antibiotic use, but not awareness of AMR. Baseline knowledge was already high in some studies, limiting the potential for improvement.
  • Evidence Statement 1.1: One non-RCT, one RCT, and one pre-post study showed mixed results.
  • Evidence Statement 1.2: Video and leaflet-based interventions in general practice improved knowledge and expectations but not AMR awareness.
  • Evidence Statement 1.3: Communication and leaflet-based interventions in general practice led to reduced antibiotic consumption.
  • Evidence Statement 1.4: Leaflet-based interventions in primary care reduced perceived need for antibiotics and improved knowledge.
  • Evidence Statement 1.5: Leaflet-based interventions with delayed prescriptions reduced inappropriate antibiotic use in some cases.
  • Evidence Statement 1.6: Interactive computerized education in A&E reduced desire for antibiotics in patients with acute respiratory infections.
  • Evidence Statement 1.7: Video and leaflet-based interventions in A&E improved knowledge and reduced antibiotic demand.
  • Evidence Statement 1.8: Culturally appropriate home-based education increased knowledge among Latino populations.
  • Evidence Statement 1.9: School-based interventions had inconsistent results, with some improving knowledge but not AMR awareness.
  • Evidence Statement 1.10: Day care-based education improved knowledge among college-educated parents.
  • Evidence Statement 1.11: Mass media campaigns had limited effectiveness in changing antibiotic knowledge and use.
  • Evidence Statement 1.12: A combination of mass media and GP interventions increased knowledge of AMR and reduced antibiotic desire.
  • Evidence Statement 1.13: Interactive science shows in holiday resorts improved children's knowledge but had a lesser effect on parents.
  • Evidence Statement 1.14: Web-based educational interventions improved attitudes towards antibiotic use but had limited impact on AMR awareness.

Research Question 2: Infection Prevention and AMR Reduction

• Infection and hand hygiene: Studies showed that educational interventions in primary care settings significantly improved knowledge of when to use antibiotics and reduced inappropriate use.
• Food safety and hygiene: Interventions targeting food safety had mixed results, with some improving knowledge but not significantly reducing AMR spread.

Main Views

• Educational interventions have shown varying degrees of success in improving public knowledge about antimicrobial use and AMR.
• Most studies were of poor quality, indicating a need for more rigorous research.
• Some interventions, such as pharmacist-led education and school-based activities, had a more positive impact.
• Cultural appropriateness and targeted delivery (e.g., to specific populations or settings) were important factors in the effectiveness of interventions.
• The effectiveness of interventions varied depending on the population and setting, with some showing greater applicability to the UK context than others.

Key Information

• Antimicrobial drugs include antibiotics, antivirals, and antifungals, which are essential for treating infections but are increasingly becoming ineffective due to AMR.
• AMR is a growing public health threat, as resistant infections are harder and more expensive to treat.
• Educational interventions are considered a key strategy in combating AMR by promoting appropriate use and infection prevention.
• The review highlights that while some interventions have shown promise, the overall evidence is limited and requires further investigation.
• Applicability to the UK: While most studies were conducted in the US, the findings are generally applicable to the UK, with some limitations due to differences in healthcare systems and populations.

Summary of Evidence Quality

Conclusion

The systematic review provides a comprehensive overview of the effectiveness and cost-effectiveness of various educational interventions aimed at changing public behaviour regarding antimicrobial use. While some interventions showed positive results, the overall evidence is limited and of mixed quality. The findings suggest that targeted, culturally appropriate, and interactive educational approaches may be more effective in improving knowledge and reducing inappropriate use. However, further research is needed to establish the long-term impact and cost-effectiveness of these interventions in the UK context.