Abstract
Introduction: In the United States, most antibiotics are prescribed in ambulatory settings. Human factors engineering, which explores interactions between people and the place where they work, has successfully improved quality of care. However, human factors engineering models have not been explored to frame what is known about ambulatory antibiotic stewardship (AS) interventions and barriers and facilitators to their implementation. Methods: We conducted a systematic review and searched OVID MEDLINE, Embase, Scopus, Web of Science, and CINAHL to identify controlled interventions and qualitative studies of ambulatory AS and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. This model describes how a work system (ambulatory clinic) contributes to a process (antibiotic prescribing) that leads to outcomes. The work system consists of 5 components, tools and technology, organization, person, tasks, and environment, within an external environment. Results: Of 1,288 abstracts initially identified, 42 quantitative studies and 17 qualitative studies met inclusion criteria. Effective interventions focused on tools and technology (eg, clinical decision support and point-of-care testing), the person (eg, clinician education), organization (eg, audit and feedback and academic detailing), tasks (eg, delayed antibiotic prescribing), the environment (eg, commitment posters), and the external environment (media campaigns). Studies have not focused on clinic-wide approaches to AS. Conclusions: A human factors engineering approach suggests that investigating the role of the clinic’s processes or physical layout or external pressures’ role in antibiotic prescribing may be a promising way to improve ambulatory AS.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 417-430 |
| Number of pages | 14 |
| Journal | Journal of the American Board of Family Medicine |
| Volume | 31 |
| Issue number | 3 |
| DOIs | |
| State | Published - May 1 2018 |
Funding
Funding: This work was supported by the Agency for Healthcare Research and Quality (AHRQ) (HHSP-233201500020I/HHSP23337003T). The findings and con- clusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. SCK received funding from the National Center for Advancing Translational Sciences/Johns Hopkins Institute for Clinical and Translational research, KL2 award KL2TR001077. Conflict of interest: none declared. This work was supported by the Agency for Healthcare Research and Quality (AHRQ) (HHSP-233201500020I/HHSP23337003T). The findings and con- clusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. SCK received funding from the National Center for Advancing Translational Sciences/Johns Hopkins Institute for Clinical and Translational research, KL2 award KL2TR001077.
Keywords
- Antibiotics
- Antimicrobial Stewardship
- Clinical Decision Support Systems
- Patient Safety
- Point-of-Care Testing
- Quality Improvement
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Family Practice