Assignment: Coordinated Treatments

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 Why is it important to integrate coordinated treatments for comorbid/co-occurring disorders?  Provide at least two examples of the potential financial challenges associated with managing the implementation of treatment. (Minimum 150 words & references)

The included studies were

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of variable quality following the application of the CASP

appraisal tool. No study explicitly addressed researcher

reflexivity, but we overlooked this. In the case of this re-

view, the emergence of similar themes across all of the

studies overcame this limitation. Through inclusion only of

studies that related to LTCFs, the importance of the context

and health care organization was protected. The synthesis

of the findings in terms of discussing factors influencing

AMS in LTCFs attempted to increase the clinical relevance

of the review results. The findings were credible, and

sufficient supportive data existed for synthesis of the

findings for the purposes of this review.

5 Conclusion

This meta-synthesis review highlighted some key influ-

ences on antibiotic prescribing in LTCFs. The specific

LTCF context factors, such as the relationship between the

GP or nurse and the patient, restricted access to resources

302 A. Fleming et al.

and social factors (for example, the central role of the

nurse) have an important impact on antibiotic prescribing

in LTCFs. The need for multidisciplinary collaborative

AMS strategies to address the variability in practice and

knowledge, and to increase the awareness of AMR, is

evident. This synthesis of existing studies may contribute

important information to the development of future high-

quality studies addressing antibiotic prescribing in LTCFs.

Acknowledgments This research was supported by the Health Research Board in Ireland under Grant Number PHD/2007/16.

Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which per-

mits any noncommercial use, distribution, and reproduction in any

medium, provided the original author(s) and the source are credited.


1. van Buul LW, van der Steen JT, Veenhuizen RB, Achterberg WP,

Schellevis FG, Essink RT, et al. Antibiotic use and resistance in

long term care facilities. J Am Med Dir Assoc. 2012;13(6):568


2. Nicolle L, Bentley D, Garibaldi R, Neuhaus E, Smith P. An-

timicrobial use in long term care facilities. Infect Control Hosp

Epidemiol. 2000;21(8):537–45.

3. Kuehn BM. ‘‘Nightmare’’ bacteria on the rise in US hospitals,

long-term care facilities. JAMA. 2013;309(15):1573–4.

4. Fleming A, Browne J, Byrne S. The effect of interventions to

reduce potentially inappropriate antibiotic prescribing in long-

term care facilities: a systematic review of randomised controlled

trials. Drugs Aging. 2013;30(6):401–8.

5. Zimmerman S, Sloane PD, Bertrand R, Olsho LE, Beeber A,

Kistler C, et al. Successfully reducing antibiotic prescribing in

nursing homes. J Am Geriatr Soc. 2014;62(5):907–12.

6. Tonkin-Crine S, Yardley L, Little P. Antibiotic prescribing for

acute respiratory tract infections in primary care: a systematic

review and meta-ethnography. J Antimicrob Chemother.


7. Charani E, Edwards R, Sevdalis N, Alexandrou B, Sibley E,

Mullett D, et al. Behavior change strategies to influence antimi-

crobial prescribing in acute care: a systematic review. Clin Infect

Dis. 2011;53(7):651–62.

8. TeixeiraRodrigues A, Roque F, Falcao A, Figueiras A, Herdeiro

MT. Understanding physician antibiotic prescribing behaviour: a

systematic review of qualitative studies. Int J Antimicrob Agents.


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