Inappropriate antimicrobial use has been shown to be an important determinant of the emergence of antimicrobial resistance (AMR). Health information technology (HIT) in the form of Computerised Decision Support (CDS) represents an option for improving antimicrobial prescribing and containing AMR. To evaluate the evidence for CDS in improving quantitative and qualitative measures of antibiotic prescribing in inpatient hospital settings. A systematic literature search was conducted of articles published from inception to 20^th December 2014 using eight electronic databases: MEDLINE, EMBASE, PUBMED, Web of Science, CINAHL, Cochrane Library, HMIC and PsychINFo. An updated systematic literature search was conducted from January 1^st 2015 to October 1^st 2016 using PUBMED. The search strategy used combinations of the following terms: (electronic prescribing) OR (clinical decision support) AND (antibiotic or antibacterial or antimicrobial) AND (hospital or secondary care or inpatient). Studies were evaluated for quality using a 10-point rating scale. Eighty-one studies were identified matching the inclusion criteria. Seven outcome measures were evaluated: adequacy of antibiotic coverage, mortality, volume of antibiotic usage, length of stay, antibiotic cost, compliance with guidelines, antimicrobial resistance, and CDS implementation and uptake. Meta-analysis of pooled outcomes showed CDS significantly improved the adequacy of antibiotic coverage (n = 13; odds ratio [OR], 2.11 [95% CI, 1.67 to 2.66, p ≤ 0.00001]). Also, CDS was associated with marginally lowered mortality (n = 20; OR, 0.85 [CI, 0.75 to 0.96, p = 0.01]). CDS was associated with lower antibiotic utilisation, increased compliance with antibiotic guidelines and reductions in antimicrobial resistance. Conflicting effects of CDS on length of stay, antibiotic costs and system uptake were also noted. CDS has the potential to improve the adequacy of antibiotic coverage and marginally decrease mortality in hospital-related settings.

In recent years, a number of studies have examined tools to identify elderly patients who are at increased risk of drug-related problems (DRPs). There has been interest in developing tools to prioritise patients for clinical pharmacist (CP) review. This systematic review (SR) aimed to identify published primary research in this area and critically evaluate the quality of prediction tools to identify elderly patients at increased risk of DRPs and/or likely to need CP intervention. The PubMed, EMBASE, OVID HMIC, Cochrane Library, PsychInfo, CINAHL PLUS, Web of Science and ProQuest databases were searched. Keeping up to date with research and citations, the reference lists of included articles were also searched to identify relevant studies. The studies involved the development, utilisation and/or validation of a prediction tool. The protocol for this SR, CRD42019115673, was registered on PROSPERO. Data were extracted and systematically assessed for quality by considering the four key stages involved in accurate risk prediction models—development, validation, impact and implementation—and following the Checklist for the critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). Nineteen studies met the inclusion criteria. Variations in study design, participant characteristics and outcomes made meta-analysis unsuitable. The tools varied in complexity. Most studies reported the sensitivity, specificity and/or discriminatory ability of the tool. Only four studies included external validation of the tool(s), namely of the BADRI model and the GerontoNet ADR Risk Score. The BADRI score demonstrated acceptable goodness of fit and good discrimination performance, whilst the GerontoNet ADR Risk Score showed poor reliability in external validation. None of the models met the four key stages required to create a quality risk prediction model. Further research is needed to either refine the tools developed to date or develop new ones that have good performance and have been externally validated before considering the potential impact and implementation of such tools.

Understanding healthcare professionals’ perceptions towards a computerised decision support system (CDSS) may provide a platform for the determinants of the successful adoption and implementation of CDSS. This cross-sectional study examined healthcare professionals’ perceptions, barriers, and facilitators to adopting a CDSS for antibiotic prescribing in Jordanian hospitals. This study was conducted among healthcare professionals in Jordan’s two tertiary and teaching hospitals over four weeks (June–July 2021). Data were collected in a paper-based format from senior and junior prescribers and non-prescribers (n = 254) who agreed to complete a questionnaire. The majority (n = 184, 72.4%) were aware that electronic prescribing and electronic health record systems could be used specifically to facilitate antibiotic use and prescribing. The essential facilitator made CDSS available in a portable format (n = 224, 88.2%). While insufficient training to use CDSS was the most significant barrier (n = 175, 68.9%). The female providers showed significantly lower awareness (p = 0.006), and the nurses showed significantly higher awareness (p = 0.041) about using electronic prescribing and electronic health record systems. This study examined healthcare professionals’ perceptions of adopting CDSS in antimicrobial stewardship (AMS) and shed light on the perceived barriers and facilitators to adopting CDSS in AMS, reducing antibiotic resistance, and improving patient safety. Furthermore, results would provide a framework for other hospital settings concerned with implementing CDSS in AMS and inform policy decision-makers to react by implementing the CDSS system in Jordan and globally. Future studies should concentrate on establishing policies and guidelines and a framework to examine the adoption of the CDSS for AMS.

Objective: The study was designed to explore the presence of any relationship between NHS secondary care antibiotic prescribing rates or primary care antibiotic prescribing rates and the levels of deprivation experienced within the referred primary care population. The study also aimed to determine whether the antibiotic prescribing rates for each care sector were correlated.Method: The study was conducted in 12 English hospital trusts of mixed size and case-mix. Antibiotic usage data (Anatomical Therapeutic Chemical (ATC) category J01) for the financial year, ending March 2001/2002 were used to calculate hospital trust prescribing rates (using the defined daily dose/finished consultant episode indicator). Primary care antibiotic prescribing data were obtained from the Prescription Pricing Authority (antibiotic items prescribed per 1000 residents) for the year 2001/2002. Index of Multiple Deprivation (IMD) 2000 deprivation data were obtained from the regional public health observatory websites for each of the primary care trusts within the relevant study areas.Key findings: No correlation could be established between the weighted index of multiple deprivation of the treated population and antibiotic prescribing rates at each hospital trust. Primary care antibiotic prescribing rates were not found to correlate with antibiotic prescribing rates in the geographically associated hospital trust. Data from all 12 sites showed that the IMD 2000 measures and primary care prescribing rates were weakly correlated, with higher antibiotic prescribing rates being generally observed in areas of primary care exhibiting the worst levels of deprivationConclusions: The likely explanations for the present findings are that deprivation-related illnesses are principally treated within primary care, whereas hospital antibiotic prescribing principally results from procedures isolated within secondary care or through the additional influence of nosocomial infection. Therefore, medicines management measures geared to controlling antibiotic prescribing in secondary care should not focus upon the levels of deprivation in the referred population, whereas those in primary care should.

Recent evidence has shown that the incidence of long-term illnesses in young people aged 10–24 years is increasing. It is essential to highlight the importance of long-term health conditions in this age group and understand young people’s health needs to be able to improve current support for young people. Pharmacists, as medicine experts, are in a unique position to promote young people’s health. The role of primary care pharmacists in the management of chronic illnesses in young people has not been widely researched. The aim of this review was to explore the current role of primary care pharmacists in the management of chronic illnesses in young people aged 10–24 years. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using Medical Subject Headings (MeSH) and Embase subject headings (Emtree) terms, covering three main themes: Pharmacists, young people and chronic illnesses. Articles were critically appraised using Critical Appraisal Skills Programme (CASP) tools. Eight articles were included in this review. Seven articles included original research studies (one observational study, two surveys, two qualitative interview studies and two interventions). The remaining article was a literature review. All of the articles made reference to community pharmacists, while there was no information about GP pharmacists. Roles that community pharmacists identified as high-priority in their practice when dealing with young people included supporting young people to develop generic healthcare skills, counselling and building trusted relationships directly with young people, helping young people to find credible health information and the provision of specialist services. Community pharmacists feel that they have a role to play in supporting young people with chronic illness and have identified many areas where they can provide services and support.