Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map

13 June, 2019

Below are the citation, abstract and author summary of a new systematic review in PLoS Medicine. We learn that 'most countries have not yet started implementing government policies to reduce their overuse and misuse of antimicrobials' and that 'most existing policy options have not been rigorously evaluated'.

CITATION: Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map

Susan Rogers Van Katwyk, Jeremy M. Grimshaw, Miriam Nkangu, Ranjana Nagi, Marc Mendelson, Monica Taljaard, Steven J. Hoffman

PLoS Medicine

Published: June 11, 2019 https://doi.org/10.1371/journal.pmed.1002819

ABSTRACT

Background: Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to reduce antimicrobial overuse. A systematic evidence map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans.

Methods and findings: Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review.

Conclusions: To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published.

AUTHOR SUMMARY

Why was this study done? Despite global commitments to reduce antimicrobial resistance and protect the effectiveness of antimicrobials, most countries have not yet started implementing government policies to reduce their overuse and misuse of antimicrobials. To the best of our knowledge, no evidence syntheses have attempted to identify the policy options available to government policy makers to tackle antimicrobial resistance by reducing antimicrobial use in humans.

What did the researchers do and find? We searched 7 academic databases to identify impact evaluations of government policy interventions aiming to reduce human antimicrobial use that were published in any language before January 28, 2019. We found 69 studies that evaluated government policy interventions to reduce antimicrobial use around the world. From these, we were able to describe 17 different types of policies that governments have used to tackle this major driver of antimicrobial resistance in humans. Commonly used policy strategies included public awareness campaigns and antimicrobial guidelines; however, other policy strategies focused on vaccination, stewardship, and changing regulations around prescribing and reimbursement. We found 4 randomized controlled trials and 35 studies using rigorous quasi-experimental designs. The remaining 30 studies used uncontrolled and descriptive study designs.

What do these findings mean? Our systematic evidence map suggests that governments have a variety of policy options at their disposal to respond to the growing threat of antimicrobial resistance. Unfortunately, most existing policy options have not been rigorously evaluated, which limits their usefulness in planning future policy interventions. To avoid wasting public resources, governments should ensure that future antimicrobial resistance policy interventions are evaluated using rigorous study designs, and that study results are published.

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Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers

http://www.hifa.org/projects/community-health-workers

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org