Life In The Slower Lane

Here is the standardised PICO analysis for the seventh uploaded article:

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Full Title

Antimicrobial prescribing in French nursing homes and interventions for antimicrobial stewardship: a qualitative study

Authors: Marie Hamard, Claire Durand, Laurène Deconinck, et al.

Journal: Antimicrobial Resistance & Infection Control, 2024; 13:142

DOI: 10.1186/s13756-024-01487-1

Type of Study

Qualitative study using semi-structured interviews with nursing home physicians in Île-de-France, France

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PICO Summary

Population (P)

• Prescribing physicians (medical coordinators, GPs, salaried doctors) working in French nursing homes
• Covered 13 physicians with a median of 3 years’ NH experience; participants worked across multiple NHs, primarily in urban, private facilities
• Indirect focus on residents, many of whom were frail, elderly, and cognitively impaired

Intervention (I)

• Antimicrobial prescribing practices and proposed Antimicrobial Stewardship (AMS) interventions, including:
  • Use of national guidelines and Clinical Decision Support Systems (e.g., Antibioclic®)
  • Feedback and audit of prescribing behaviours
  • Tailored educational strategies
  • Clarified roles for medical coordinators and nurses
  • Improved access to diagnostics and infectious disease specialists
  • Development of facility-specific AMS protocols

Comparison (C)

• No direct comparator group; instead, this study identifies barriers and enablers in current prescribing practices and proposes strategies for improvement

Outcomes (O)

Person-centred outcomes:

• Not directly reported, though patient well-being was considered a key motivator for empirical antimicrobial use

Process outcomes:

• Identification of prescribing determinants, including:
  • Resident factors (age, comorbidities, swallowing ability)
  • Environmental context (lack of diagnostic tools, high staff turnover, delayed lab results)
  • Physician perceptions (low perceived priority, reliance on habits, comfort with “common infections”)
  • Limited resident/family involvement due to cognitive impairment

Health system outcomes:

• Recommendations for AMS implementation, including:
  • Development of tailored guidelines
  • Integration of CDSS into routine practice
  • Structured audit and feedback
  • Defined leadership by medical coordinators
  • Training and empowerment of nurses 

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Findings Summary

• Antimicrobial prescribing is often empirical, driven by discomfort, uncertainty, or fear of deterioration rather than diagnostic confirmation
• Physicians perceive AMS as important but not urgent, with focus often placed on other priorities (nutrition, behaviour, end-of-life care)
• Study proposes that effective stewardship must be context-sensitive, multimodal, and built on interprofessional collaboration and local leadership
• The role of the medical coordinator is central but often underutilised in current practice 

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