Communication Dans Un Congrès Année : 2025

CO4.1 - Enhancing antimicrobial stewardship implementation in nursing homes: ORANEAT participatory approach to develop implementation strategies tailored to the context

Faciliter la mise en œuvre d'un programme de bon usage des antibiotiques en EHPAD : une approche participative pour développer des stratégies d'implémentation adaptées au contexte, dans le cadre du programme ORANEAT

Résumé

Background and objective Antimicrobial resistance (AMR) is among the top 10 global health threats, particularly in nursing homes (NHs). Antimicrobial stewardship (AMS) programs (i.e., a coherent set of actions which promote using antimicrobials responsibly) have shown effective in various healthcare settings. However, evidence from NHs reveals inconsistent results and low implementation success due to the specific challenges posed by resident characteristics and organizational factors. The methods used so far to develop implementation strategies for AMS programs in NHs appear to have yielded rather poor and ineffective results. As part of ORANEAT project, whose overarching goal is to develop and evaluate a customizable AMS program for French NHs, we proposed a participatory approach to develop implementation strategies tailored to the context thereby maximizing the chances of implementation. The aim of the present communication is to describe this innovative participative approach. Material and Methods We set up an advisory committee (AC) gathering main NH AMS stakeholders (n=24) selected from the two regions participating in ORANEAT: NH directors, coordinating physicians and nurses, assistant nurses, residents’ representatives, general practitioners, community pharmacists and microbiologists, and AMS specialists. The resulting AC then participated in a four-step “World Café”: (i) identifying key stakeholders to be involved in the program implementation; (ii) brainstorming to generate implementation strategies; (iii) prioritizing the resulting strategies according to their potential value and feasibility; (iv) operationalizing the prioritized implementation strategies. Results During a first online meeting, AC mapped the stakeholders and their potential influence on adoption and/or implementation of ORANEAT AMS program. Overall, we identified 12 stakeholders from inner NH setting and 12 stakeholders from outer setting. A second onsite meeting resulted in the generation of 135 implementation strategies: 57 generic strategies (i.e., related to overall ORANEAT AMS program), and 78 specific strategies relating to one of ORANEAT program components. Among these specific implementation strategies, 17 related to contextual diagnosis and 61 to AMS actions as defined by the Centers for Disease Control and Prevention, i.e., “practices to improve antibiotic use” (n=27), “accountability” (n=3), “education (training and awareness-raising)” (n=31). During the third online meeting, 16/57 generic strategies were prioritized and grouped in 5 categories adapted from the Expert Recommendations for Implementing Change project: adapt implementation to the NH context (n=2); inform, engage, and train all stakeholders concerned (n=4); develop stakeholder interrelationships (n=3); organize implementation monitoring (n=2); create supportive environments (n=5). AC also provided insights on how to implement each of the prioritized implementation strategies (e.g., format, content, timing, stakeholders). Conclusion This participatory approach resulted in implementation strategies to be tested using a hybrid randomized controlled trial, and further refined if necessary, before considering scaling-up of ORANEAT program. The method used to develop these implementation strategies could be useful in other complex intervention development settings.

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hal-05079535 , version 1 (22-05-2025)

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Aurélie Bocquier, G. Birgand, C. Dumartin, Nelly Agrinier. CO4.1 - Enhancing antimicrobial stewardship implementation in nursing homes: ORANEAT participatory approach to develop implementation strategies tailored to the context. EPICLIN 2025, 19ème Conférence francophone d’Épidémiologie Clinique et 32èmes Journées des Statisticiens des Centres de Lutte Contre le Cancer, May 2025, Bordeaux, France. pp.203003, ⟨10.1016/j.jeph.2025.203003⟩. ⟨hal-05079535⟩
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