Assessment of implementation strategies adopted for antimicrobial stewardship interventions in long-term care facilities: a systematic review.

BACKGROUND: The implementation of antimicrobial stewardship (AMS) interventions in long-term care facilities (LTCFs) is influenced by multi-level factors (resident, organizational, and external) making their effectiveness sensitive to the implementation context. OBJECTIVES: This study assessed the strategies adopted for the implementation of AMS interventions in LTCFs, whether they considered organizational characteristics, and their effectiveness. DATA SOURCES: Electronic databases until April 2022. STUDY ELIGIBILITY CRITERIA: Articles covering implementation of AMS interventions in LTCFs. ASSESSMENT OF RISK OF BIAS: Mixed Methods Appraisal Tool for empirical studies. METHODS OF DATA SYNTHESIS: Data were collected on AMS interventions and context characteristics (e.g. type of facility, staffing, and residents). Implementation strategies and outcomes were mapped according to the Expert Recommendations for Implementing Change (ERIC) framework and validated taxonomy for implementation outcomes. Implementation and clinical effectiveness were assessed according to the primary and secondary outcomes results provided in each study. RESULTS: Among 48 studies included in the analysis, 19 (40%) used implementation strategies corresponding to one to three ERIC domains, including education and training (n = 36/48, 75%), evaluative and iterative strategies (n = 24/48, 50%), and support clinicians (n = 23/48, 48%). Only 8/48 (17%) studies made use of implementation theories, frameworks, or models. Fidelity and sustainability were reported respectively in 21 (70%) and 3 (10%) of 27 studies providing implementation outcomes. Implementation strategy was considered effective in 11/27 (41%) studies, mainly including actions to improve use (n = 6/11, 54%) and education (n = 4/11, 36%). Of the 42 interventions, 18/42 (43%) were deemed clinically effective. Among 21 clinically effective studies, implementation was deemed effective in four and partially effective in five. Two studies were clinically effective despite having non-effective implementation. CONCLUSIONS: The effectiveness of AMS interventions in LTCFs largely differed according to the interventions' content and implementation strategies adopted. Implementation frameworks should be considered to adapt and tailor interventions and strategies to the local context.

Cultivating participatory approaches in health promotion planning, delivery, and evaluation: A case study of an academic-health service partnership in rural Victoria.

ISSUE ADDRESSED: Community participation in planning, delivery, and evaluation of health promotion (HP) programs is a poorly explored topic. However, this approach has the potential to improve health outcomes and reduce health inequities, particularly for residents of rural and remote areas. METHODS: This case study describes the outputs of an academic-health service partnership in rural Victoria. The collaboration has led to the implementation and ongoing evaluation of a microgrant program for HP which integrates community participation principles in the foundations of the program and its evaluation. RESULTS: To date, 10 funded projects have been brought to completion, with COVID-19 having disturbed both grant distribution and funded activity implementation. Semi-structured interviews with health service officers served to clarify conceptualisation and operationalization of HP principles. Focus groups with health service management and officers contributed to building an overarching evaluation framework for the HP team's activities. Finally, the specific methodological evaluation framework for the microgrant program was developed through a collaborative workshop with the HP team and grantees. CONCLUSIONS: Fostering community participation in HP planning, delivery, and evaluation, especially in rural areas, is feasible as evidenced by the experience described in this case study. The forthcoming evaluation results will help clarify the impact of community participation on health-related outcomes. SO WHAT?: Documentation and dissemination of processes used to increase community participation in HP programs is essential to grow the knowledge base around what works and what doesn't, and for whom.

Qualitative assessment of the national initiative to implement antimicrobial stewardship centres in French administrative regions.

BACKGROUND: In May 2020, the French Ministry of Health funded the creation of regional antimicrobial stewardship (AMS) coordination centres (CRAtb) in preparation for the new national framework for the prevention of antimicrobial resistance. This study aimed to assess through qualitative methods the implementation process, the activities carried out, and the interactions with other regional stakeholders of the newly created CRAtb. METHODS: We conducted a mixed-method study based on a cross-sectional survey and semi-structured interviews by French regions among implemented CRAtb. Of the eight eligible French regions with an existing CRAtb, seven participated to the online survey. Regional partners involved in AMS from the eight regions were interviewed between September 2021 and April 2022. The survey questionnaire addressed, through closed questions, the organization of the CRAtb, articulation with other regional actors involved in AMS and infection prevention and control (IPC), and AMS activities. The semi-structured interviews approached the implementation and the role of CRAtb, and the collaboration of other AMS and IPC stakeholders. Interview transcripts were analysed using thematic content analysis methodology. RESULTS: AMS activities carried out by CRAtb were mainly focusing on hospitals (n = 3), primary care (n = 2) and nursing homes (n = 1). Education mostly relied on training days and AMS help lines, communication on websites and newsletters. CRAtb members reported still being more engaged in providing advice to professionals for individual antibiotic treatments rather than collective-level AMS activities. Interactions were frequent between CRAtb, IPC regional centres and health authorities, but rarely involved other stakeholders. Interviews were performed with 28 professionals involved in AMS from eight regions. Pre-existing networks and working relationships in AMS and more broadly facilitated the implementation of CRAtb. Streamlining and decompartmentalizing IPC and AMS regional activities were considered a way to optimise the prevention of antimicrobial resistance across sectors. The engagement with liberal health professionals was identified as a significant obstacle for CRAtb. CONCLUSIONS: Two years after the launch of a new national framework, the implementation of CRAtb appeared complex in most regions. An integrative model joining IPC and AMS efforts, relying on existing networks, with engagement from liberal health profession organisations may be the next pivotal step.

Evaluation Methods in Community Microgrant Programs for Health Promotion: A Scoping Review.

CONTEXT: Evaluating community-based health promotion programs is an essential aspect of public health programming to ensure evidence-based practices, justify limited resource allocation, and share knowledge about promising strategies. Community microgrant schemes represent a viable strategy to strengthen local health promotion, yet limited guidance exists surrounding the evaluation of such programs. OBJECTIVE: This research aimed to map methods used in evaluating community microgrants programs for health promotion. DESIGN: A scoping review in accordance with Joanna Briggs Institute methodology. ELIGIBILITY CRITERIA: Peer-reviewed academic and gray literature, which evaluated processes and/or outcomes of nonprescriptive community-based microgrant program for health promotion in high-income countries. STUDY SELECTION: Literature was identified through MEDLINE, Scopus, CINAHL, and EMBASE databases, Google and DuckDuckGo browsers, and hand-searching key reference lists. Articles were screened by title, abstract, and then full-text. MAIN OUTCOME MEASURES: Review findings were mapped according to included sources' evaluation methodologies. RESULTS: Eighteen academic publications describing 14 microgrant programs met the inclusion criteria. These spanned the years 1996 to 2020 and were located across 5 countries. Evaluation methods were very similar in terms of design (mixed-methods case studies) and focus (both processes and outcomes) and yet varied widely with regard to measurements and data collection. Few made explicit the use of an evaluation framework, chose to involve stakeholders in the evaluation process, or discussed application and dissemination of evaluation findings. DISCUSSION: Community-based microgrant programs for health promotion are a promising model in diverse settings and with various health priorities and targets, yet robust evaluations of their implementation and effectiveness are lacking. The review highlights the need to further develop and support evaluation practices in public health, even in small-scale programs with limited budgets.

[Health Exam for Adults Over 65 program in Andalusia: descriptive study of participants.] / Programa examen de salud para personas mayores de 65 años en Andalucía: estudio descriptivo de participantes.

OBJECTIVE: The Health Exam for Adults Over 65 (EdS65+) is a health promotion program delivered in Primary Care (PC) settings in Andalusia. It seeks early detection of frailty and implementation of person-centered biopsychosocial intervention plans. The aim of the study was to describe the characteristics and functional capacity of the participating population, as well as the interventions carried out. METHODS: The sample consists of EdS65+ participants between May 2018 and February 2020 (203,077 individuals). Sociodemographic variables, functional capacity and implemented interventions were collected. Descriptive statistics were obtained and significance tests were performed to measure the sample representativeness and to detect statistically significant differences in the study variables according to sex, age or degree of urbanization. RESULTS: Functional capacity screening results were as follows: autonomous individuals accounted for 61.8%, 22.5% were dependent, 8.2% were pre-fragile, 4.8% were frail and 2.6% were categorized with low dependency. The prevalence of frailty ranged from 1.8% in persons aged 65-69 years to 7.7% in 80-84 years, with overall prevalence of 6.8% in women and 2.1% in men. In the frail population, a basic assessment was performed in 45.4% of cases, health promotion counseling in 55.2%, and prescription of a physical activity program in 43.3% of cases. A total of 19.6% of participants had one or more follow-ups and of these, 13.7% had two or more. CONCLUSIONS: EdS65+ is a unique program in Europe in terms of its long-term implementation and large-scale application in Primary Care services. Hence, the results presented in this study are valuable in growing the knowledge base around frailty and the design and implementation of actions aimed at proactive health promotion and disease prevention.

OBJETIVO: El Examen de Salud para mayores de 65 años (EdS65+) es un programa de promoción de la salud contextualizado en la Atención Primaria (AP) de Andalucía. Busca detectar precozmente la fragilidad y determinar planes de intervención biopsicosociales centrados en la persona. El objetivo del estudio fue describir las características y la capacidad funcional de la población participante, así como las intervenciones realizadas. METODOS: Muestra formada por participantes en EdS65+ entre mayo 2018 y febrero 2020 (203.077 personas). Se recogieron variables sociodemográficas, de capacidad funcional e intervenciones realizadas. Se obtuvieron estadísticos descriptivos y se realizaron pruebas de significación para medir la representatividad de la muestra y detectar diferencias estadísticamente significativas de las variables de estudio según sexo, edad o grado de urbanización. RESULTADOS: Las personas autónomas representaron el 61,8%, seguido del 22,5% de dependientes, 8,2% prefrágiles, 4,8% frágiles y 2,6% con baja dependencia. La prevalencia de fragilidad fue desde el 1,8% en personas de 65-69 años al 7,7% en 80-84 años, del 6,8% en mujeres y del 2,1% en hombres. En población frágil se realizó una valoración básica en el 45,4%, asesoramiento en promoción de la salud en el 55,2% y prescripción de un programa de actividad física en el 43,3%. Un 19,6% tuvo uno o más seguimientos y, de ellos, un 13,7% tuvo dos o más. CONCLUSIONES: El EdS65+ es un programa único en Europa en cuanto a su implementación a largo plazo y su aplicación a gran escala en los servicios de Atención Primaria, lo que hace que los resultados presentados en este estudio aporten gran valor al conocimiento de la fragilidad y al diseño y puesta en marcha de actuaciones dirigidas a la promoción proactiva de la salud y la prevención de la enfermedad.