Barriers and facilitators of implementing an antimicrobial stewardship intervention for urinary tract infection in a long-term care facility

April J. Chan*, Denis O’Donnell, Benjamin Kaasa, Annalise Mathers, Alexandra Papaioannou, Kevin Brazil, Nicoleta Paraschiv, Mark Goldstein, Cheryl Sadowski, Lisa Dolovich

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Fifty percent of antibiotic courses in long-term care facilities (LTCFs) are unnecessary, leading to increased risk of harm. Most studies to improve antibiotic prescribing in LTCFs showed modest and unsustained results. We aimed to identify facilitators, barriers and strategies in implementing a urinary tract infection (UTI)–focused antimicrobial stewardship (AS) intervention at a LTCF, with the secondary objective of exploring the pharmacist’s potential roles. Methods: The study used a qualitative descriptive design. Participants attended either a focus group or one-on-one interview. Data were analyzed inductively using a codebook modified in an iterative analytic process. Barrier and facilitator themes were mapped using the capability, opportunity, motivation and behaviour (COM-B) model. Similarly, themes were identified from the transcripts regarding the pharmacist’s roles. Results: Sixteen participants were interviewed. Most barriers and facilitators mapped to the opportunities domain of the COM-B model. The main barrier themes were lack of access, lack of knowledge, ineffective communication, lack of resources and external factors, while the main facilitator themes were education, effective collaboration, good communication, sufficient resources and access. For the pharmacist’s role, the barrier themes were ineffective collaboration and communication. Conclusion: This study supports the importance of tailoring interventions to target factors underlying barriers to behaviour change. At this LTCF, an effective antimicrobial stewardship intervention should incorporate strategies to improve access, knowledge, communication and collaboration in its design, having sufficient resources and addressing external factors to optimize its success and long-term sustainability. 

Original languageEnglish
JournalCanadian Pharmacists Journal
Early online date16 Feb 2021
Publication statusEarly online date - 16 Feb 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2021.

Copyright 2021 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

  • Pharmacy
  • Pharmaceutical Science


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