Interventions to improve antimicrobial prescribing of doctors in training: the IMPACT (IMProving Antimicrobial presCribing of doctors in Training) realist review.
BACKGROUND
Antimicrobial resistance has been described as a global crisis-more prudent prescribing is part of the solution. Behaviour change interventions are needed to improve prescribing practice. Presently, the literature documents that context impacts on prescribing decisions, yet insufficient evidence exists to enable researchers and policymakers to determine how local tailoring should take place. Doctors in training are an important group to study, being numerically the largest group of prescribers in UK hospitals. Unfortunately very few interventions specifically targeted this group.


METHODS
Our project aims to understand how interventions to change antimicrobial prescribing behaviours of doctors in training produce their effects. We will recruit a project stakeholder group to advise us throughout. We will synthesise the literature using the realist review approach-a form of theory-driven interpretive systematic review approach often used to make sense of complex interventions. Interventions to improve antimicrobial prescribing behaviours are complex-they are context dependent, have long implementation chains, multiple non-linear interactions, emergence and depend on human agency. Our review will iteratively progress through 5 steps: step 1--Locate existing theories; step 2--Search for evidence; step 3--Article selection; step 4--Extracting and organising data; and step 5--Synthesising the evidence and drawing conclusions. Data analysis will use a realist logic of analysis to describe and explain what works, for whom, in what circumstances, in what respects, how and why to improve antimicrobial prescribing behaviour of doctors in training.


BACKGROUND
Ethical approval was not required for our review. Our dissemination strategy will be participatory and involve input from our stakeholder group. Tailored project outputs will be targeted at 3 audiences: (1) doctors in training; (2) clinical supervisors/trainers and medical educators; and (3) policy, decision makers, regulators and royal societies.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Geoff
G
Wong
Collaboration for the Advancement of Medical Education Research Assessment, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
Nicola
N
Brennan
University of Exeter Medical School, University of Exeter, Exeter, UK.
Karen
K
Mattick
Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula, University of Exeter Medical School, Exeter, UK.
Mark
M
Pearson
University of Exeter Medical School, University of Exeter, Exeter, UK.
Simon
S
Briscoe
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Chrysanthi
C
Papoutsi
D000890:Anti-Infective Agents / Q000008:administration & dosage*; D003657:Decision Making; D011307:Drug Prescriptions / Q000592:standards*; D004501:Education, Medical / Q000592:standards*; D006801:Humans; D010820:Physicians; D012107:Research Design; D012196:Review Literature as Topic
D000890:Anti-Infective Agents
EDUCATION & TRAINING (see Medical Education & Training); INFECTIOUS DISEASES; MICROBIOLOGY