title: Implementation of antimicrobial stewardship interventions recommended by national toolkits in primary and secondary healthcare sectors in England: TARGET and Start Smart Then Focus.
abstract: OBJECTIVE
  To assess and compare the implementation of antimicrobial stewardship (AMS) interventions recommended within the national AMS toolkits, TARGET and Start Smart Then Focus, in English primary and secondary healthcare settings in 2014, to determine the prevalence of cross-sector engagement to drive AMS interventions and to propose next steps to improve implementation of AMS.
  
  
  METHODS
  Electronic surveys were circulated to all 211 clinical commissioning groups (CCGs; primary sector) and to 146 (out of the 159) acute trusts (secondary sector) in England. Response rates were 39% and 63% for the primary and secondary sectors, respectively.
  
  
  RESULTS
  The majority of CCGs and acute trusts reported reviewing national AMS toolkits formally or informally (60% and 87%, respectively). However, only 13% of CCGs and 46% of acute trusts had developed an action plan for the implementation of these toolkits. Only 5% of CCGs had antimicrobial pharmacists in post; however, the role of specialist antimicrobial pharmacists continued to remain embedded within acute trusts, with 83% of responding trusts having an antimicrobial pharmacist at a senior grade.
  
  
  CONCLUSIONS
  The majority of healthcare organizations review national AMS toolkits; however, implementation of the toolkits, through the development of action plans to deliver AMS interventions, requires improvement. For the first time, we report the extent of cross-sector and multidisciplinary collaboration to deliver AMS interventions in both primary and secondary care sectors in England. Results highlight that further qualitative and quantitative work is required to explore mutual benefits and promote best practice. Antimicrobial pharmacists remain leaders for implementing AMS interventions across both primary and secondary healthcare sectors.
authors: Antimicrobial Resistance Programme, Public Health England, London, UK diane.ashiru-oredope@phe.gov.uk.
authors: D
authors: D
authors: Ashiru-Oredope
authors: Antimicrobial Resistance Programme, Public Health England, London, UK.
authors: E L
authors: EL
authors: Budd
authors: Antimicrobial Resistance Programme, Public Health England, London, UK.
authors: A
authors: A
authors: Bhattacharya
authors: Department of Pharmaceutics, UCL School of Pharmacy, UCL, London, UK.
authors: N
authors: N
authors: Din
authors: Primary Care Unit, Public Health England, Gloucester Royal Hospital, Gloucester, UK.
authors: C A M
authors: CA
authors: McNulty
authors: Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK National Institute for Health Research Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK.
authors: C
authors: C
authors: Micallef
authors: Pharmacy Department, East & North Herts NHS Trust, Hertford, UK.
authors: D
authors: D
authors: Ladenheim
authors: NHS Bath and North East Somerset Clinical Commissioning Group, Bath, UK NHS England Patient Safety Domain 5, London, UK.
authors: E
authors: E
authors: Beech
authors: Department of Pharmaceutics, UCL School of Pharmacy, UCL, London, UK.
authors: S
authors: S
authors: Murdan
authors: Antimicrobial Resistance Programme, Public Health England, London, UK.
authors: S
authors: S
authors: Hopkins
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000592:standards*; D004739:England; D019983:Guideline Adherence; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D011320:Primary Health Care / Q000379:methods*; D063127:Secondary Health Care / Q000379:methods*
chemical_list: D000890:Anti-Infective Agents