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      Feasibility Study of the World Health Organization Health Care Facility-Based Antimicrobial Stewardship Toolkit for Low- and Middle-Income Countries

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          Abstract

          Antimicrobial stewardship (AMS) has emerged as a systematic approach to optimize antimicrobial use and reduce antimicrobial resistance. To support the implementation of AMS programs, the World Health Organization developed a draft toolkit for health care facility AMS programs in low- and middle-income countries. A feasibility study was conducted in Bhutan, the Federated States of Micronesia, Malawi, and Nepal to obtain local input on toolkit content and implementation of AMS programs. This descriptive qualitative study included semi-structured interviews with national- and facility-level stakeholders. Respondents identified AMS as a priority and perceived the draft toolkit as a much-needed document to further AMS program implementation. Facilitators for implementing AMS included strong national and facility leadership and clinical staff engagement. Barriers included lack of human and financial resources, inadequate regulations for prescription antibiotic sales, and insufficient AMS training. Action items for AMS implementation included improved laboratory surveillance, establishment of a stepwise approach for implementation, and mechanisms for reporting and feedback. Recommendations to improve the AMS toolkit’s content included additional guidance on defining the responsibilities of the committees and how to prioritize AMS programming based on local context. The AMS toolkit was perceived to be an important asset as countries and health care facilities move forward to implement AMS programs.

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          Most cited references 21

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          Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.

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            Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation

            Background Much research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes. In this article, we present an approach to using the Consolidated Framework for Implementation Research (CFIR) to guide systematic research that supports rapid-cycle evaluation of the implementation of health care delivery interventions and produces actionable evaluation findings intended to improve implementation in a timely manner. Methods To present our approach, we describe a formative cross-case qualitative investigation of 21 primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a multi-payer supported primary care practice transformation intervention led by the Centers for Medicare and Medicaid Services. Qualitative data include observational field notes and semi-structured interviews with primary care practice leadership, clinicians, and administrative and medical support staff. We use intervention-specific codes, and CFIR constructs to reduce and organize the data to support cross-case analysis of patterns of barriers and facilitators relating to different CPC components. Results Using the CFIR to guide data collection, coding, analysis, and reporting of findings supported a systematic, comprehensive, and timely understanding of barriers and facilitators to practice transformation. Our approach to using the CFIR produced actionable findings for improving implementation effectiveness during this initiative and for identifying improvements to implementation strategies for future practice transformation efforts. Conclusions The CFIR is a useful tool for guiding rapid-cycle evaluation of the implementation of practice transformation initiatives. Using the approach described here, we systematically identified where adjustments and refinements to the intervention could be made in the second year of the 4-year intervention. We think the approach we describe has broad application and encourage others to use the CFIR, along with intervention-specific codes, to guide the efficient and rigorous analysis of rich qualitative data. Trial registration NCT02318108 Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0550-7) contains supplementary material, which is available to authorized users.
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              How we design feasibility studies.

              Public health is moving toward the goal of implementing evidence-based interventions. To accomplish this, there is a need to select, adapt, and evaluate intervention studies. Such selection relies, in part, on making judgments about the feasibility of possible interventions and determining whether comprehensive and multilevel evaluations are justified. There exist few published standards and guides to aid these judgments. This article describes the diverse types of feasibility studies conducted in the field of cancer prevention, using a group of recently funded grants from the National Cancer Institute. The grants were submitted in response to a request for applications proposing research to identify feasible interventions for increasing the utilization of the Cancer Information Service among underserved populations.
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                Author and article information

                Journal
                Antibiotics (Basel)
                Antibiotics (Basel)
                antibiotics
                Antibiotics
                MDPI
                2079-6382
                29 August 2020
                September 2020
                : 9
                : 9
                Affiliations
                [1 ]Division of Infectious Disease, Henry Ford Health System, Detroit, MI 48202, USA; mzervos1@ 123456hfhs.org
                [2 ]World Health Organization, 1202 Geneva, Switzerland; ismith@ 123456who.int (I.S.); paulins@ 123456who.int (S.P.)
                [3 ]Global Health Initiative, Henry Ford Health System, Detroit, MI 48202, USA; LKaljee1@ 123456hfhs.org (L.K.); TPRENTI1@ 123456hfhs.org (T.P.)
                [4 ]Ministry of Health, 207218 Lilongwe, Malawi; watipasokasa@ 123456yahoo.com (W.K.); rhodamgb@ 123456gmail.com (J.M.)
                [5 ]Jigme Dorji Wangchuck National Referral Hospital, 11001 Thimpu, Bhutan; pchuki@ 123456jdwnrh.gov.bt
                [6 ]Department of Infectious Diseases, Christian Medical College, Vellore 632004, India; priscillarupali@ 123456yahoo.com
                [7 ]Ministry of Health and Population, 44600 Kathmandu, Nepal; dipendra2028@ 123456gmail.com
                [8 ]Group for Technical Assistance, 44600 Kathmandu, Nepal; bajra.deepak@ 123456gmail.com
                [9 ]Department of Health & Social Affairs, 96941 Pohnpei, Federated States of Micronesia; lbarrow@ 123456fsmhealth.fm (L.B.); ejohnson@ 123456fsmhealth.fm (E.J.)
                [10 ]School of Medicine, Wayne State University, Detroit, MI 48202, USA
                Author notes
                [* ]Correspondence: gmaki1@ 123456hfhs.org ; Tel.: +1-313-829-5751
                Article
                antibiotics-09-00556
                10.3390/antibiotics9090556
                7558985
                32872440
                © 2020 World Health Organization;

                Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (CC BY) license ( http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organisation or products. The use of the WHO logo is not permitted.

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