APS - Ações educativas para a comunidade e para pais de pacientes pediátricos3131 Hu Y, Walley J, Chou R, Tucker JD, Harwell JI, Wu X, Yin J, Zou G, Wei X. Interventions to reduce childhood antibiotic prescribing for upper respiratory infections: Systematic review and meta-analysis. J Epidemiol Community Health 2016; 70(12):1162-1170.,3636 Bal AM, Gould IM. Antibiotic stewardship: Overcoming implementation barriers. Curr Opin Infect Dis 2011; 24(4):357-362. Ambulatórios - Estratégias para a melhoria da comunicação entre prescritores e pacientes1717 Drekonja DM, Filice GA, Greer N, Olson A, MacDonald R, Rutks I, Wilt TJ. Antimicrobial stewardship in outpatient settings: A systematic review. Infect Control Hosp Epidemiol 2015; 36(2):142-152.,3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473. - Decisão compartilhada entre paciente e profissional da saúde no tratamento3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473.,3838 Bassetti M, Poulakou G, Ruppe E, Bouza E, Van Hal SJ, Brink A. Antimicrobial resistance in the next 30 years, humankind, bugs and drugs: a visionary approach. Intensive Care Med 2017; 43(10):1464-1475. |
APS - Satisfação de usuários e cuidadores quanto a prescrição terapêutica3131 Hu Y, Walley J, Chou R, Tucker JD, Harwell JI, Wu X, Yin J, Zou G, Wei X. Interventions to reduce childhood antibiotic prescribing for upper respiratory infections: Systematic review and meta-analysis. J Epidemiol Community Health 2016; 70(12):1162-1170.,3232 Andrews T, Thompson M, Buckley DI, Heneghan C, Deyo R, Redmond N, Lucas PJ, Blair PS, Hay AD. Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: a systematic review and meta-analysis. PLoS One 2012; 7(1):e30334. Ambulatórios - Necessidade do usuário em receber prescrição de antibióticos2828 O'Sullivan JW, Harvey RT, Glasziou PP, McCullough A. Written information for patients (or parents of child patients) to reduce the use of antibiotics for acute upper respiratory tract infections in primary care. Cochrane Database Syst Rev 2016; 11:CD011360.,3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473. |
APS - Melhor organização do processo de trabalho e envolvimento de representantes dos profissionais de saúde na tomada de decisão para a escolha das estratégias que serão implementadas1717 Drekonja DM, Filice GA, Greer N, Olson A, MacDonald R, Rutks I, Wilt TJ. Antimicrobial stewardship in outpatient settings: A systematic review. Infect Control Hosp Epidemiol 2015; 36(2):142-152.,3636 Bal AM, Gould IM. Antibiotic stewardship: Overcoming implementation barriers. Curr Opin Infect Dis 2011; 24(4):357-362.,3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473.,3939 Özgenç O. Methodology in improving antibiotic implementation policies. World J Methodol 2016; 6(2):143.,4040 Tamma PD, Cosgrove SE. Antimicrobial stewardship. Infect Dis Clin North Am 2011; 25(1):245-260. Ambulatórios - Acesso e a utilização de sistemas eletrônicos1717 Drekonja DM, Filice GA, Greer N, Olson A, MacDonald R, Rutks I, Wilt TJ. Antimicrobial stewardship in outpatient settings: A systematic review. Infect Control Hosp Epidemiol 2015; 36(2):142-152. - Realização de testes rápidos2525 Aabenhus R, Jensen J-US, Jorgensen KJ, Hrobjartsson A, Bjerrum L. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database Syst Rev 2014; (11):CD010130. - Ações educativas ativas, tempo para profissionais a executarem dentro do trabalho3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473.,4141 D'Agata EMC. Antimicrobial use and stewardship programs among dialysis centers. Semin Dial 2013; 26(4):457-464. - Ações educativas a distância2525 Aabenhus R, Jensen J-US, Jorgensen KJ, Hrobjartsson A, Bjerrum L. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database Syst Rev 2014; (11):CD010130. - Monitoramento e a avaliação periódicas3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473.,4242 Cunha CB, D'Agata EMC. Implementing an antimicrobial stewardship program in out-patient dialysis units. Curr Opin Nephrol Hypertens 2016; 25(6):551-555. - Escolha de uma pessoa-chave que seja respeitada pelos outros profissionais de saúde4242 Cunha CB, D'Agata EMC. Implementing an antimicrobial stewardship program in out-patient dialysis units. Curr Opin Nephrol Hypertens 2016; 25(6):551-555. |
APS - Tentativa do prescritor em satisfazer a expectativa do usuário2828 O'Sullivan JW, Harvey RT, Glasziou PP, McCullough A. Written information for patients (or parents of child patients) to reduce the use of antibiotics for acute upper respiratory tract infections in primary care. Cochrane Database Syst Rev 2016; 11:CD011360.,3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473. - Crenças do conhecimento empírico, medo e insegurança do prescritor2828 O'Sullivan JW, Harvey RT, Glasziou PP, McCullough A. Written information for patients (or parents of child patients) to reduce the use of antibiotics for acute upper respiratory tract infections in primary care. Cochrane Database Syst Rev 2016; 11:CD011360.,3232 Andrews T, Thompson M, Buckley DI, Heneghan C, Deyo R, Redmond N, Lucas PJ, Blair PS, Hay AD. Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: a systematic review and meta-analysis. PLoS One 2012; 7(1):e30334.,3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473.,4040 Tamma PD, Cosgrove SE. Antimicrobial stewardship. Infect Dis Clin North Am 2011; 25(1):245-260.,4444 Van Buul LW, Sikkens JJ, Van Agtmael MA, Kramer MHH, Van der Steen JT, Hertogh CMPM. Participatory action research in antimicrobial stewardship: A novel approach to improving antimicrobial prescribing in hospitals and long-term care facilities. J Antimicrob Chemother 2014; 69(7):1734-1741.,4545 Cox JA, Vlieghe E, Mendelson M, Wertheim H, Ndegwa L, Villegas MV, Gould I, Hara GL. Antibiotic stewardship in low- and middle-income countries: the same but different? Clin Microbiol Infect 2017; 23(11):812-818.,4949 Warreman EB, Lambregts MMC, Wouters RHP, Visser LG, Staats H, van Dijk E, Boer MGJ. Determinants of in-hospital antibiotic prescription behaviour: a systematic review and formation of a comprehensive framework. Clin Microbiol Infect 2019; 25(5):538-545. - Falta de materiais e recursos adequados e organização inadequada do trabalho4040 Tamma PD, Cosgrove SE. Antimicrobial stewardship. Infect Dis Clin North Am 2011; 25(1):245-260.,4545 Cox JA, Vlieghe E, Mendelson M, Wertheim H, Ndegwa L, Villegas MV, Gould I, Hara GL. Antibiotic stewardship in low- and middle-income countries: the same but different? Clin Microbiol Infect 2017; 23(11):812-818.,4949 Warreman EB, Lambregts MMC, Wouters RHP, Visser LG, Staats H, van Dijk E, Boer MGJ. Determinants of in-hospital antibiotic prescription behaviour: a systematic review and formation of a comprehensive framework. Clin Microbiol Infect 2019; 25(5):538-545. Ambulatórios - Insegurança dos prescritores na escolha terapêutica2828 O'Sullivan JW, Harvey RT, Glasziou PP, McCullough A. Written information for patients (or parents of child patients) to reduce the use of antibiotics for acute upper respiratory tract infections in primary care. Cochrane Database Syst Rev 2016; 11:CD011360.,3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473. - Falta de familiaridade dos profissionais com os sistemas, ou interrupção não prevista no fluxo de trabalho1717 Drekonja DM, Filice GA, Greer N, Olson A, MacDonald R, Rutks I, Wilt TJ. Antimicrobial stewardship in outpatient settings: A systematic review. Infect Control Hosp Epidemiol 2015; 36(2):142-152.,3333 Patel SJ, Larson EL, Kubin CJ, Saiman L. A review of antimicrobial control strategies in hospitalized and ambulatory pediatric populations. Pediatr Infect Dis J 2007; 26(6):531-537.,3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473. - Falta de adesão dos profissionais de saúde às diretrizes clínicas66 Keller SC, Tamma PD, Cosgrove SE, Miller MA, Sateia H, Szymczak J, Gurses AP, Linder JA. Ambulatory antibiotic stewardship through a human factors engineering approach: A systematic review. J Am Board Fam Med 2018; 31(3):417-430.,3333 Patel SJ, Larson EL, Kubin CJ, Saiman L. A review of antimicrobial control strategies in hospitalized and ambulatory pediatric populations. Pediatr Infect Dis J 2007; 26(6):531-537. - Vínculo afetivo entre o médico e paciente influi na prescrição de antibióticos66 Keller SC, Tamma PD, Cosgrove SE, Miller MA, Sateia H, Szymczak J, Gurses AP, Linder JA. Ambulatory antibiotic stewardship through a human factors engineering approach: A systematic review. J Am Board Fam Med 2018; 31(3):417-430. |
APS - Inclusão do tema da resistência microbiana na agenda de prioridades para fortalecimento de políticas4343 World Health Organisation (WHO). Turning Plans into Action for Antimicrobial Resistance (AMR) Working Paper 2.0: Implementation and Coordination [Internet]. 2019 [cited 2019 nov 1]. Available from: https://www.who.int/antimicrobial-resistance/publications/AMR-Turning-plans-into-action-working-paper-march-2019.pdf. https://www.who.int/antimicrobial-resist...
,4444 Van Buul LW, Sikkens JJ, Van Agtmael MA, Kramer MHH, Van der Steen JT, Hertogh CMPM. Participatory action research in antimicrobial stewardship: A novel approach to improving antimicrobial prescribing in hospitals and long-term care facilities. J Antimicrob Chemother 2014; 69(7):1734-1741.,4545 Cox JA, Vlieghe E, Mendelson M, Wertheim H, Ndegwa L, Villegas MV, Gould I, Hara GL. Antibiotic stewardship in low- and middle-income countries: the same but different? Clin Microbiol Infect 2017; 23(11):812-818. - Estratégias de educação e suporte técnico3636 Bal AM, Gould IM. Antibiotic stewardship: Overcoming implementation barriers. Curr Opin Infect Dis 2011; 24(4):357-362.,4343 World Health Organisation (WHO). Turning Plans into Action for Antimicrobial Resistance (AMR) Working Paper 2.0: Implementation and Coordination [Internet]. 2019 [cited 2019 nov 1]. Available from: https://www.who.int/antimicrobial-resistance/publications/AMR-Turning-plans-into-action-working-paper-march-2019.pdf. https://www.who.int/antimicrobial-resist...
,4646 Allerberger F, Lechner A, Wechsler-Fördös A, Gareis R. Optimization of antibiotic use in hospitals - Antimicrobial stewardship and the EU Project ABS International. Chemotherapy 2008; 54(4):260-267.,4747 Allerberger F, Frank A, Gareis R, et al. Antibiotic stewardship through the EU project "ABS International". Wien Klin Wochenschr 2008; 120(9-10):256-263. Ambulatórios - Desenvolvimento de diretrizes, seminários e mesas redondas sobre o tema3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473.,4141 D'Agata EMC. Antimicrobial use and stewardship programs among dialysis centers. Semin Dial 2013; 26(4):457-464.,4242 Cunha CB, D'Agata EMC. Implementing an antimicrobial stewardship program in out-patient dialysis units. Curr Opin Nephrol Hypertens 2016; 25(6):551-555.,4848 Bishop BM. Antimicrobial Stewardship in the Emergency Department: Challenges, Opportunities, and a Call to Action for Pharmacists. J Pharm Pract 2016; 29(6):556-563. |
APS - Problemas de acesso à informação, adaptação de diretrizes e falta de pactuação de planos e políticas3636 Bal AM, Gould IM. Antibiotic stewardship: Overcoming implementation barriers. Curr Opin Infect Dis 2011; 24(4):357-362.,4343 World Health Organisation (WHO). Turning Plans into Action for Antimicrobial Resistance (AMR) Working Paper 2.0: Implementation and Coordination [Internet]. 2019 [cited 2019 nov 1]. Available from: https://www.who.int/antimicrobial-resistance/publications/AMR-Turning-plans-into-action-working-paper-march-2019.pdf. https://www.who.int/antimicrobial-resist...
,4545 Cox JA, Vlieghe E, Mendelson M, Wertheim H, Ndegwa L, Villegas MV, Gould I, Hara GL. Antibiotic stewardship in low- and middle-income countries: the same but different? Clin Microbiol Infect 2017; 23(11):812-818.,5050 Schuetz P, Bolliger R, Merker M, Christ-Crain M, Stolz D, Tamm M, Luyt CE, Wolff M, Schroeder S, Nobre V, Reinhart K, Branche A, Damas P, Nijsten M, Deliberato RO, Verduri A, Beghé B, Cao B, Shehabi Y, Jensen J-US, Beishuizen A, Jong E, Briel M, Welte T, Mueller B. Procalcitonin-guided antibiotic therapy algorithms for different types of acute respiratory infections based on previous trials. Expert Rev Anti Infect Ther 2018; 16(7):555-564. Ambulatórios - Disponibilidades de materiais e recursos adequados, sistemas eletrônicos e organização do trabalho ineficientes66 Keller SC, Tamma PD, Cosgrove SE, Miller MA, Sateia H, Szymczak J, Gurses AP, Linder JA. Ambulatory antibiotic stewardship through a human factors engineering approach: A systematic review. J Am Board Fam Med 2018; 31(3):417-430.,3737 Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc 2017; 57(4):464-473.,4848 Bishop BM. Antimicrobial Stewardship in the Emergency Department: Challenges, Opportunities, and a Call to Action for Pharmacists. J Pharm Pract 2016; 29(6):556-563. |