Assignment: Application Of Correlation

Conclusion This review highlighted the key contextual

challenges for AMS in LTCFs. The findings provide an in-

depth insight into the factors—such as the LTCF context,

social factors, variability in knowledge and prescribing

practices, and antimicrobial resistance—that impact on

antibiotic prescribing and AMS strategies. These factors

must be considered in order to ensure the feasibility and

applicability of future AMS interventions.

Key Points

The influences of the long-term care facility (LTCF)

context and social factors have an important impact

on antibiotic prescribing in this setting.

According to the findings of this review, future

antimicrobial stewardship strategies must emphasize

the importance of knowledge of guidelines and

antimicrobial resistance, and the strategies must be

specifically designed for implementation in the

LTCF setting.

1 Introduction

Recent studies evaluating the prescribing of antibiotics in

long-term care facilities (LTCFs) have found that antibiotic

prescribing is common, with reported annual prevalence

rates ranging from 47 to 79 % [1]. As many as 25–75 % of

Electronic supplementary material The online version of this article (doi:10.1007/s40266-015-0252-2) contains supplementary material, which is available to authorized users.

& Aoife Fleming [email protected]

1 Pharmaceutical Care Research Group, School of Pharmacy,

University College Cork, Cork, Ireland

2 Department of General Practice, University College Cork,

Cork, Ireland

Drugs Aging (2015) 32:295–303

DOI 10.1007/s40266-015-0252-2

antibiotic prescriptions in LTCFs are inappropriate in terms

of their indication, dose or duration of therapy [2]. Through

reductions in antibiotic prescribing and encouragement of

appropriate use of antibiotics, the rates of antimicrobial

resistance (AMR) and adverse drug events can be reduced

[3]. The few antimicrobial stewardship (AMS) intervention

studies that have been conducted in LTCFs have reported

modest effects, which were often not sustained [4, 5]. In

order to establish how best to address AMS strategies in

LTCFs, the factors that influence antibiotic prescribing

behaviours must be determined and understood. There is a

need for detailed awareness and understanding of the be-

haviour of all health care professionals involved in LTCF

antibiotic prescribing.

There have been several qualitative review papers

evaluating influences on antibiotic prescribing in primary

and secondary care settings [6–8]. Qualitative studies in-

vestigating antibiotic prescribing in LTCFs have been

conducted, but, to date, there has not been an overall

synthesis of these studies. Synthesis of knowledge is im-

portant to bring together the findings of individual studies

in order to further the understanding of a given issue [9]. A

qualitative meta-synthesis integrates and compares findings

across different studies, and the accumulated knowledge

may lead to development of a new theory, narrative or

interpretive translation [9, 10]. Synthesis of information

from existing qualitative studies may help to contribute to

AMS strategies in LTCFs.

The objective of this qualitative meta-synthesis was to

synthesize the qualitative research findings that have col-

lected health care professionals’ and administrators’ views

of the factors influencing antibiotic prescribing in LTCFs.

2 Methods

2.1 Search Strategy

The following databases were searched from their incep-

tion until July 2014