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Educational interventions and contextual factors for optimising antibiotic prescription in paediatric uncomplicated acute respiratory tract infections in primary care: scoping review of reviews.
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1. BMC Pediatr. 2025 May 26;25(1):421. doi: 10.1186/s12887-025-05688-4.
Educational interventions and contextual factors for optimising antibiotic
prescription in paediatric uncomplicated acute respiratory tract infections in
primary care: scoping review of reviews.
Elizondo-Alzola U(1)(2), Rocha C(3)(4), Leache L(5)(6), León-García M(1), Saiz
LC(6)(7), Solà I(3)(8), Montesinos-Guevara C(9), Meade AG(3), Boldú A(3),
Bolíbar I(8)(10)(11), Niño-de-Guzmán E(12)(13)(14), Alonso-Coello P(15)(16).
Author information:
(1)Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain.
(2)Primary Care Pharmacy, Debagoiena Integrated Health Organisation, Osakidetza
Basque Health Service, Arrasate, Spain.
(3)Centro Cochrane Iberoamericano, Institut de Recerca Sant Pau (IR Sant Pau),
Barcelona, Spain.
(4)Avedis Donabedian Research Institute, Barcelona, Spain.
(5)Pharmacy and Services Sub-Directorate, Navarre Health Service, Pamplona,
Navarre, Spain.
(6)Navarra Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain.
(7)Unit of Innovation and Organization, Navarre Health Service, Pamplona,
Navarre, Spain.
(8)CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
(9)Centro de Investigación en Epidemiología Clínica y Salud Pública (CISPEC),
Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito,
Ecuador.
(10)Servicio de Epidemiología y Salud Pública, Hospital de la Santa Creu i Sant
Pau, Barcelona, Spain.
(11)Universitat Autònoma de Barcelona, Barcelona, Spain.
(12)Centro Cochrane Iberoamericano, Institut de Recerca Sant Pau (IR Sant Pau),
Barcelona, Spain. ena.ninodeguzman@gmail.com.
(13)Quality, Process and Innovation Direction, Vall d'Hebron University
Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.
ena.ninodeguzman@gmail.com.
(14)Health Services Research Group, Vall d'Hebron Institut de Recerca, Vall
d'Hebron University Hospital, Barcelona, Spain. ena.ninodeguzman@gmail.com.
(15)Centro Cochrane Iberoamericano, Institut de Recerca Sant Pau (IR Sant Pau),
Barcelona, Spain. palonso@santpau.cat.
(16)CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
palonso@santpau.cat.
BACKGROUND: Inappropriate antibiotic prescription in paediatric uncomplicated
acute respiratory tract infections (ARTIs) in primary care (PC) settings
contributes to antimicrobial resistance. We aimed (1) to identify and describe
educational interventions and their components to optimise antibiotic
prescription for paediatric uncomplicated ARTIs in PC, and (2) to map contextual
factors that may influence antibiotic prescription and the implementation of
interventions.
METHODS: We searched three electronic databases (Medline, CINAHL and
Epistemonikos) to identify reviews on the effectiveness of educational
interventions and contextual factors, for optimising antibiotic prescription
(Concept) in paediatric uncomplicated ARTIs (Population) in PC (Context). We
included reviews that reported explicitly the search strategy used. Two
previously calibrated reviewers independently screened the literature, extracted
data, and assessed the methodological limitations. We applied the "best-fit
framework synthesis approach", based on the main constructs of the Consolidated
Framework for Implementation Research, and coded the data deductively by groups
of analysis for reviews reporting effectiveness (e.g. antibiotic or consultation
rate) or by thematic synthesis for reviews reporting contextual factors (e.g.
healthcare professionals' knowledge) based on a logic model.
RESULTS: We identified 11 reviews evaluating education intervention and their
characteristics, including 182 interventions with at least one educational
component (educational intervention plus another type, educational or
non-educational), with 136 providing information on characteristics and
effectiveness. Successful interventions' characteristics were related to the
kind of intervention (e.g. communication skill training), mode of delivery (e.g.
face to face), and target population (e.g. parents/caregivers). From the 22
reviews on contextual factors, healthcare professionals' attitudes and
perceptions, knowledge, and health system and professionals' teams' organization
(inner setting), were the most frequent themes; less information was available
on individuals´ characteristics (parents/children) and on outer setting (e.g.
policies).
CONCLUSION: We identified a large number of heterogeneous educational
interventions. Combining educational interventions plus another type targeting
both parents/caregivers and healthcare professionals, and considering their
needs and their context may improve antibiotic prescribing in children. Further
research is needed on consultation rate, knowledge, attitudes, and satisfaction
outcomes and contextual factors, as well as on the cost-effectiveness of the
interventions.
REGISTRATION: The protocol was published in OSF iRegistries in May 2021
(Elizondo-Alzola, U).
© 2025. The Author(s).
DOI: 10.1186/s12887-025-05688-4
PMID: 40420306 [Indexed for MEDLINE]
Conflict of interest statement: Declarations. Ethics approval and consent to
participate: Research ethics approval is not required for this scoping review.
However, the results of this review were used to develop the interventions of a
clinical trial (OptimAP project) that has been approved by the IDIAP Jordi Gol
Clinical Research Ethic Committee (reference number 19/019-P). Besides, the
Ethic Committees of each of the participating Autonomous Communities in Spain
have also approved the project. Consent for publication: Not applicable.
Competing interests: The authors declare no competing interests.
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