Article Dans Une Revue JAC-Antimicrobial Resistance Année : 2024

Exploration of interprofessional collaboration for the diagnosis of infections and antibiotic prescription in nursing homes using multiple case study observational research

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Background Antibiotic resistance in nursing homes (NHs) is inconsistently tackled by antimicrobial stewardship programmes. The literature on individual determinants of antibiotic prescriptions (APs) in NHs is extensive. However, less is known about the structural determinants of AP in NHs. Objectives To examine how different organizational contexts influenced interprofessional collaboration in the diagnosis and treatment of infections in NHs. Methods We conducted multiple case study observational research through field notes and sketches from pictures of NH layouts. Results We observed three NHs for 10 days (i.e. 82 h). We inductively identified four successive steps: (i) trigger by an assistant nurse, (ii) internal decision-making, (iii) calling on an external general practitioner (GP) and (iv) GP intervention. Diagnosis and treatment of infections involved various degrees of interprofessional collaboration within NHs, resulting in a range of actions, more or less directly involving AP by external GPs. In the case of onsite AP, external GPs barely relied on information about residents provided by NH professionals and did not provide any feedback regarding their decision, resulting in limited interprofessional collaboration. In contrast, remote AP (through phone calls) relied on interprofessional collaboration through mandatory exchanges between external GPs and NH nurses about the resident’s symptoms and signs. Conclusions Diagnosis and treatment of infections through AP involved two distinct organization types (institutional versus private practices) and often lacked interprofessional collaboration. Future antimicrobial stewardship in NHs should consider (i) improving the connection between these two organizations and (ii) developing tools to support remote interprofessional collaboration to sustain prescription.
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hal-04911233 , version 1 (24-01-2025)

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Damien Gonthier, Laetitia Ricci, Marie Buzzi, Gabriel Birgand, Joëlle Kivits, et al.. Exploration of interprofessional collaboration for the diagnosis of infections and antibiotic prescription in nursing homes using multiple case study observational research. JAC-Antimicrobial Resistance, 2024, 7 (1), ⟨10.1093/jacamr/dlae205⟩. ⟨hal-04911233⟩
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