IMPACT: Improving Rational Prescribing of Antibiotics in Long-term Care Facilities.

IMPACT employs a controlled pre-post test mixed-methods design. The first phase (pre-test) comprises an observational study to examine appropriateness of antibiotic prescribing in nursing homes and residential care facilities. The second phase of the study comprises an intervention study. After the identification of barriers with regard to antibiotic prescribing using qualitative methods, long-term care facilities in the intervention group are provided the opportunity to select interventions that each facility perceives as most useful. The selected interventions are implemented and the effectiveness is measured. The long-term care facilities in the control group will treat infections as usual, and receive the interventions at the conclusion of the data collection.

The prescribing of antibiotics in long-term care facilities can be optimized.

Primary outcomes data collection: Continuously over 20 months by using a form.

Secondary outcomes: After 8 months and 20 months by using interviews and focus groups.

The 'general intervention' comprises an approach whereby long-term care facilities are guided in the identification of local barriers, perceived by staff, with regard to optimal antibiotic prescribing. These barriers are addressed by selecting 'specific interventions' from an 'array of interventions' and by tailoring these intervention to the local needs. Although the 'general intervention' is the same for all participating long-term care facilities, selected 'specific interventions' may differ between those facilities.