Optimizing antibiotic prescribing: collective approaches to managing a common-pool resource.

Anti-Infective Agents / therapeutic use Antimicrobial Stewardship / organization & administration Drug Resistance, Microbial Drug Utilization / standards Humans
Antimicrobial stewardship Bacterial Choice behaviour Drug resistance Health resources Humans Prescribing Social dilemma

Journal

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420

Informations de publication

Date de publication:
Nov 2019
Historique:
received: 21 12 2018
revised: 08 03 2019
accepted: 10 03 2019
pubmed: 27 3 2019
medline: 6 2 2020
entrez: 27 3 2019
Statut: ppublish

Résumé

Antimicrobial resistance (AMR) is one of the greatest threats in 21st century medicine. AMR has been characterized as a social dilemma. A familiar version describes the situation in which a collective resource (in this case, antibiotic efficacy) is exhausted due to over-exploitation. The dilemma arises because individuals are motivated to maximize individual payoffs, although the collective outcome is worse if all act in this way. We aim to outline the implications for antimicrobial stewardship of characterizing antibiotic overuse as a social dilemma. We conducted a narrative review of the literature on interventions to promote the conservation of resources in social dilemmas. The social dilemma of antibiotic over-use is complicated by the lack of visibility and imminence of AMR, a loose coupling between individual actions and the outcome of AMR, and the agency relationships inherent in the prescriber role. We identify seven strategies for shifting prescriber behaviour and promoting a focus on the collectively desirable outcome of conservation of antibiotic efficacy: (1) establish clearly defined boundaries and access rights; (2) raise the visibility and imminence of the problem; (3) enable collective choice arrangements; (4) conduct behaviour-based monitoring; (5) use social and reputational incentives and sanctions; (6) address misalignment of goals and incentives; and (7) provide conflict resolution mechanisms. We conclude that this theoretic analysis of antibiotic stewardship could make the problem of optimizing antibiotic prescribing more tractable, providing a theory base for intervention development.

Sections du résumé

BACKGROUND BACKGROUND
Antimicrobial resistance (AMR) is one of the greatest threats in 21st century medicine. AMR has been characterized as a social dilemma. A familiar version describes the situation in which a collective resource (in this case, antibiotic efficacy) is exhausted due to over-exploitation. The dilemma arises because individuals are motivated to maximize individual payoffs, although the collective outcome is worse if all act in this way.
OBJECTIVES OBJECTIVE
We aim to outline the implications for antimicrobial stewardship of characterizing antibiotic overuse as a social dilemma.
SOURCES METHODS
We conducted a narrative review of the literature on interventions to promote the conservation of resources in social dilemmas.
CONTENT BACKGROUND
The social dilemma of antibiotic over-use is complicated by the lack of visibility and imminence of AMR, a loose coupling between individual actions and the outcome of AMR, and the agency relationships inherent in the prescriber role. We identify seven strategies for shifting prescriber behaviour and promoting a focus on the collectively desirable outcome of conservation of antibiotic efficacy: (1) establish clearly defined boundaries and access rights; (2) raise the visibility and imminence of the problem; (3) enable collective choice arrangements; (4) conduct behaviour-based monitoring; (5) use social and reputational incentives and sanctions; (6) address misalignment of goals and incentives; and (7) provide conflict resolution mechanisms.
IMPLICATIONS CONCLUSIONS
We conclude that this theoretic analysis of antibiotic stewardship could make the problem of optimizing antibiotic prescribing more tractable, providing a theory base for intervention development.

Identifiants

DOI: 10.1016/j.cmi.2019.03.008 PMID: 30910716
pubmed: 30910716
pii: S1198-743X(19)30110-7
doi: 10.1016/j.cmi.2019.03.008
pii:
doi:

Substances chimiques

Anti-Infective Agents 0

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1356-1363

Informations de copyright

Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Auteurs

C Tarrant (C)

Department of Health Sciences, University of Leicester, Leicester, UK. Electronic address: ccp3@le.ac.uk.

A M Colman (AM)

Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.

E Chattoe-Brown (E)

School of Media, Communication and Sociology, University of Leicester, Leicester, UK.

D R Jenkins (DR)

Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK.

S Mehtar (S)

Tygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.

N Perera (N)

Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK.

E M Krockow (EM)

Department of Health Sciences, University of Leicester, Leicester, UK.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Optimizing antibiotic prescribing: collective...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Assurance de la qualité des soins de santé › Bilan opérationnel › Revue des pratiques de prescription des médicaments › Gestion responsable des antimicrobiens › Optimizing antibiotic prescribing: collective...
questionsmedicales.fr › Phénomènes physiologiques › Phénomènes pharmacologiques et toxicologiques › Phénomènes pharmacologiques › Résistance aux substances › Résistance microbienne aux médicaments › Optimizing antibiotic prescribing: collective...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration pharmacie › Utilisation médicament › Optimizing antibiotic prescribing: collective...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Optimizing antibiotic prescribing: collective...