pplication of Correlation
For this discussion:
Identify a research question from your professional life or career specialization that can be addressed by a correlation.
Indicate why a correlation would be the appropriate analysis for this research question.
Describe the variables and their scale of measurement.
Discuss the expected outcome—positive, negative, no relationship.
Conclusion This review highlighted the key contextual
challenges for AMS in LTCFs. The findings provide an in-
depth insight into the factors—such as the LTCF context,
social factors, variability in knowledge and prescribing
practices, and antimicrobial resistance—that impact on
antibiotic prescribing and AMS strategies. These factors
must be considered in order to ensure the feasibility and
applicability of future AMS interventions.
Key Points
The influences of the long-term care facility (LTCF)
context and social factors have an important impact
on antibiotic prescribing in this setting.
According to the findings of this review, future
antimicrobial stewardship strategies must emphasize
the importance of knowledge of guidelines and
antimicrobial resistance, and the strategies must be
specifically designed for implementation in the
LTCF setting.
1 Introduction
Recent studies evaluating the prescribing of antibiotics in
long-term care facilities (LTCFs) have found that antibiotic
prescribing is common, with reported annual prevalence
rates ranging from 47 to 79 % [1]. As many as 25–75 % of
Electronic supplementary material The online version of this article (doi:10.1007/s40266-015-0252-2) contains supplementary material, which is available to authorized users.
& Aoife Fleming a.fleming@ucc.ie
1 Pharmaceutical Care Research Group, School of Pharmacy,
University College Cork, Cork, Ireland
2 Department of General Practice, University College Cork,
Cork, Ireland
Drugs Aging (2015) 32:295–303
DOI 10.1007/s40266-015-0252-2
antibiotic prescriptions in LTCFs are inappropriate in terms
of their indication, dose or duration of therapy [2]. Through
reductions in antibiotic prescribing and encouragement of
appropriate use of antibiotics, the rates of antimicrobial
resistance (AMR) and adverse drug events can be reduced
[3]. The few antimicrobial stewardship (AMS) intervention
studies that have been conducted in LTCFs have reported
modest effects, which were often not sustained [4, 5]. In
order to establish how best to address AMS strategies in
LTCFs, the factors that influence antibiotic prescribing
behaviours must be determined and understood. There is a
need for detailed awareness and understanding of the be-
haviour of all health care professionals involved in LTCF
antibiotic prescribing.
There have been several qualitative review papers
evaluating influences on antibiotic prescribing in primary
and secondary care settings [6–8]. Qualitative studies in-
vestigating antibiotic prescribing in LTCFs have been
conducted, but, to date, there has not been an overall
synthesis of these studies. Synthesis of knowledge is im-
portant to bring together the findings of individual studies
in order to further the understanding of a given issue [9]. A
qualitative meta-synthesis integrates and compares findings
across different studies, and the accumulated knowledge
may lead to development of a new theory, narrative or
interpretive translation [9, 10]. Synthesis of information
from existing qualitative studies may help to contribute to
AMS strategies in LTCFs.
The objective of this qualitative meta-synthesis was to
synthesize the qualitative research findings that have col-
lected health care professionals’ and administrators’ views
of the factors influencing antibiotic prescribing in LTCFs.
2 Methods
2.1 Search Strategy
The following databases were searched from their incep-
tion until July 2014
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