CRediT contribution statement
Aziz Sheikh (https://orcid.org/0000-0001-7022-3056): Conceptualisation (equal), Data curation (lead), Methodology (lead), Supervision (lead), Funding acquisition (lead), Writing – reviewing and editing (supporting).
Jamie Coleman (https://orcid.org/0000-0002-7512-5153): Conceptualisation (equal), Data curation (lead), Methodology (lead), Supervision (lead), Writing – reviewing and editing (supporting).
Antony Chuter (https://orcid.org/0000-0002-0646-5939): Writing – reviewing and editing (supporting).
Jillian Beggs (https://orcid.org/0000-0002-7591-3256): Writing – reviewing and editing (supporting).
Richard Lilford (https://orcid.org/0000-0002-0634-984X): Conceptualisation (equal), Methodology (lead), Supervision (lead), Data curation (lead), Writing – reviewing and editing (supporting).
Kathrin Cresswell (https://orcid.org/0000-0001-6634-9537): Conceptualisation (equal), Data curation (lead).
Christopher Weir (https://orcid.org/0000-0002-6494-4903): Conceptualisation (equal), Methodology (lead), Supervision (lead), Data curation (lead).
Robin Williams (https://orcid.org/0000-0002-9044-4611): Conceptualisation (equal), Data curation (lead), Methodology (lead), Supervision (lead) Writing – reviewing and editing (supporting).
Other contributions
Ann Slee (https://orcid.org/0000-0002-9731-7041): Advisor.
Sarah Slight (https://orcid.org/0000-0002-0339-846X): Research team member.
Hajar Mozaffar (https://orcid.org/0000-0002-6400-5260): Researcher (supporting).
Sarah Pontefract (https://orcid.org/0000-0002-0344-4075): Researcher (supporting).
Neil Watson (https://orcid.org/0000-0002-5024-8456): Research team member.
James Mason (https://orcid.org/0000-0001-9210-4082): Research team member.
Lucy Yardley (https://orcid.org/0000-0002-3853-883X): Research team member.
David Bates (https://orcid.org/0000-0001-6268-1540): Support.
Susan Hopkins (https://orcid.org/0000-0001-5179-5702): Support.
Omara Dogar (https://orcid.org/0000-0002-7122-8403): Researcher.
Sue Hinder (https://orcid.org/0000-0001-8451-2027): Researcher (supporting), Analyst.
Acknowledgements
The authors would like to thank staff and patients at the participating hospital sites, representatives from patient organisations and all other informants for providing data for this programme. We would also like to thank the (anonymous) clinical staff who had provided valuable support. Our PPI panel gave essential feedback on the design of research carried out, the tools used and the dissemination of the findings. The PPI panel included Jillian Beggs and Antony Chuter. We are indebted to our IPSC who provided clear and supportive guidance during the 5.5-year programme. The IPSC was chaired by Emeritus Denis Protti, University of Victoria, Canada, co-chaired by Laura Shallcross, Professor of Public Health and Translational Data Science, Institute of Health Informatics, University College London and included, Sir Munir Pirmohamed, Professor of Molecular and Clinical Pharmacology, the University of Liverpool, Charis Marwick, Clinical Reader Population Health and Genomics University of Dundee.
The authors would also like to acknowledge the eDRIS team (Public Health Scotland) for their support in obtaining approvals, for facilitating access to study data within the National Safe Haven and for performing disclosure checking of outputs prior to release for publication. We would like to thank participants in this work, who have given their time despite immense pressures during the COVID-19 pandemic. We would like to thank Celia Brown, Honorary Professor, University of Warwick, for developing the causal model to evaluate the cost-effectiveness of ASPs in the economic analysis. Many thanks also to Sam Watson, University of Birmingham, for his invaluable statistical guidance and for undertaking the meta-analysis of the relationship between DDD and CDI. Thanks also to the expert panel that comprised the consultative committee for their input to elicit parameters of the economic model and valuable insight on the approaches to costing of interventions. We would like to thank Luiz Andrade and Pamela Nayyar for undertaking the scoping review of economic evaluation studies of ASPs.
We would also like to thank all the researchers who have contributed to the study at various levels. We would to thank the NIHR programme managers Fiona Giles and Lousia Needham for all the guidance and support. We would like to thank Lucy Yardley, Professor of Health Psychology, School of Psychological Science, University of Bristol and School of Psychology, University of Southampton. She is a NIHR Senior Investigator, and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West and NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation. We gratefully acknowledge everyone who contributed directly and indirectly contributed to this project from start till end. We gratefully acknowledge Antony Chuter and Jillian Beggs for their PPI contributions.
Data-sharing statement
All available data can be obtained by contacting the corresponding author, and access to anonymised data may be granted following review. Also, we shall make data available to the scientific community with as few restrictions as feasible, while retaining exclusive use until the publication of major outputs. The qualitative part of the study and the data generated is not suitable for sharing beyond that contained within the manuscript. Further information can be obtained from the corresponding author.
Ethics statement
The study has received ethics approval from North of Scotland Research Ethics service, NHS Grampian on 6 February 2020. Also, specific WPs gained approval from NHS R&D England, under NIHR clinical research network support.
Information governance statement
University of Edinburgh is committed to handling all personal information in line with the UK Data Protection Act (2018) and the General Data Protection Regulation (EU GDPR) 2016/679. Under the Data Protection legislation, University of Edinburgh is the Data Controller, and you can find out more about how we handle personal data, including how to exercise your individual rights, and our Data Protection Officer can be contacted at dpo@ed.ac.uk.
Disclosure of interests
Full disclosure of interests: Completed ICMJE forms for all authors, including all related interests, are available in the toolkit on the NIHR Journals Library report publication page at https://doi.org/10.3310/GJAS1007.
Primary conflicts of interest: Richard Lilford is a current member of the National Institute for Health and Care Research (NIHR) Global Health Researcher-Led Groups Funding Committee, 2024–present, NIHR MRC Trials Methodology Research Partnership Outcomes Working Group, 2025–present. Ann Slee reports personal fees from NHS Wales, personal fees from PCS Health Ltd, outside the submitted work. David Bates is a co-inventor on patent number 6029138, which is held by Brigham and Women’s Hospital (USA) on the use of decision support software for medical management, held by Medicalis Corporation. He holds a minority equity position in the privately held company Medicalis, which develops web-based decision support for radiology test ordering. He serves on the Board for SEA Medical Systems, which makes intravenous pump technology. He is on the clinical advisory board for Zynx, Inc., which develops evidence-based algorithms. He consults for EarlySense, which makes patient safety monitoring systems. He received cash and equity from QPID, Inc., a company focused on intelligence systems for electronic health records. He receives cash compensation from CDI (Negev), Ltd, which is a non-for-profit incubator for health IT start-ups. He receives equity from Enelgy, which makes software to support clinical decision-making in intensive care. He receives equity from MDClone, which takes clinical data and produces deidentified version of it. He also receives equity from Valera Health, which makes software to help patients with chronic diseases; and equity from Intensix, which makes software to support clinical decision-making in intensive care. His financial interests have been reviewed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their institutional policies. Sarah Slight is a member of the Health Technology Assessment Primary Care, Community and Preventive Interventions Panel.
No competing interests are reported for any other authors.
Copyright and credit statement
Every effort has been made to obtain the necessary permissions for reproduction, to credit original sources appropriately and to respect copyright requirements. However, despite our diligence, we acknowledge the possibility of unintentional omissions or errors, and we welcome notifications of any concerns regarding copyright or permissions.
Publications
Jenkins JA, Pontefract SK, Cresswell K, Williams R, Sheikh A, Coleman JJ. Antimicrobial stewardship using electronic prescribing systems in hospital settings: a scoping review of interventions and outcome measures. JAC Antimicrob Resist 2022;4:dlac063. https://doi.org/10.1093/jacamr/dlac063
Cresswell K, Anderson S, Montgomery C, Weir CJ, Atter M, Williams R. Evaluation of digitalisation in healthcare and the quantification of the ‘unmeasurable’. J Gen Intern Med 2023;38:3610–5. https://doi.org/10.1007/s11606-023-08405-y
Cresswell K, Hinder S, Sheikh A, Pontefract S, Watson NW, Price D, Williams R. ePrescribing-Based Antimicrobial Stewardship Practices in an English National Health Service Hospital: qualitative interview study among medical prescribers and pharmacists. JMIR Form Res 2023;7:e37863. https://doi.org/10.2196/37863
Trotter N, Slight S, Karimi R, Bates D, Sheikh A, Weir C, Tolley C. The effect of digital antimicrobial stewardship programmes on antimicrobial usage, length of stay, mortality and cost. Inform Med Unlocked 2023. https://doi.org/10.1016/j.imu.2023.101183
Weir C, Adamestam I, Sharp R, Ennis H, Heed A, Williams R, Sheikh A. A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial. Pilot Feasibility Stud 2023;9:18. https://doi.org/10.1186/s40814-022-01230-w
Cresswell K, Hinder S, Sheikh A, Watson N, Price D, Heed A, et al. Complex hospital-based electronic prescribing-based intervention to support antimicrobial stewardship: qualitative study. JMIR Form Res 2024;8:e54458. https://doi.org/10.2196/54458
Nyyar P, Brown C, Andrade L, Lilford R. Health economic studies of antimicrobial stewardship programmes: a scoping review. NIHR Open Res 2024;4:78. https://doi.org/10.3310/nihropenres.13726.1
Weir C, Hinder S, Adamestam I, Sharp R, Ennis H, Heed A, Sheikh A. A complex ePrescribing antimicrobial stewardship-based (ePAMS+) intervention for hospitals: mixed-methods feasibility trial results. BMC Med Inform Decis Mak 2024;24:301. https://doi.org/10.1186/s12911-024-02707-9
Cresswell K, Hinder S, Williams R. A qualitative study exploring electronic health record optimisation activities in English hospitals. Int J Med Inform 2025;198:105868. https://doi.org/10.1016/j.ijmedinf.2025.105868
Disclaimers
This article presents independent research funded by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, CCF, PGfAR or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, the PGfAR programme or the Department of Health and Social Care.