Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study

Abstract

The overuse of antimicrobials in primary care can be linked to an increased risk of antimicrobial-resistant bacteria for individual patients. Although there are promising signs of the benefits associated with Antimicrobial Stewardship Programs (ASPs) in hospitals and long-term care settings, there is limited knowledge in primary care settings and how to implement ASPs in these settings is unclear. In this context, a qualitative study was undertaken to explore the perceptions of primary care prescribers of the usefulness, feasibility, and experiences associated with the implementation of a pilot community-focused ASP intervention in three primary care clinics. Qualitative interviews were conducted with primary care clinicians, including local ASP champions, prescribers, and other primary health care team members, while they participated in an ASP initiative within one of three primary care clinics. An iterative conventional content analyses approach was used to analyze the transcribed interviews. Themes emerged around the key enablers and barriers associated with ASP implementation. Study findings point to key insights relevant to the scalability of community ASP activities with primary care providers.

Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study

“…Additionally, a lack of IT support, timely access to diagnostic and antibiogram reports, and availability to each other that hindered study CPs' ability to query or communicate with GPs. Jeffs et al [37] echoed these barriers what was commonly faced by primary care prescribers including pharmacists when making decisions about antimicrobial(s). The mandatory integration of clinical indications into patients' MHRs and telehealth-led reviewing of antimicrobial prescription(s) might increase the digital interpretability of antimicrobial prescriptions and case-conferencing where necessary to assure appropriateness of antimicrobial recommendations by CPs.…”

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

“…Ideally, such intervention components require a relatively small commitment of resources on the healthcare provider side, increase guideline concordance and foster a decrease of overuse and inappropriate prescribing [ 12 ]. Different models of implementing such antimicrobial stewardship programs in primary care have already been evaluated, including physician education [ 13 , 14 ], audit and feedback [ 15 , 16 , 17 ], electronic clinical decision support [ 18 ], peer comparison [ 19 , 20 , 21 ], and more [ 22 , 23 ]. To our knowledge, this process evaluation is the first to evaluate an implementation program that combined several of these components and tested them in a primary care network setting.…”

Barriers of Appropriate Antibiotic Prescription at PHCC in Qatar: Perspective of Physicians and Pharmacists

“…Another well-documented barrier to preventing the appropriate antibiotic prescribing which is found in other studies has been the influence of patient pressure [ 19 ]. Jeffs et al (2020) state that patients would often pressurize their physicians to prescribe antibiotics based on their preconceived notion of a previous experience of feeling better [ 20 ]. This patient pressure has been highlighted in the PHCC practices by physicians across Qatar.…”

“…For these recommended solutions to be successful, a multipronged approach is needed whereby there is an increase in the collective responsibility across all healthcare providers and healthcare workers that is enforced with government support and key stakeholders [ 19 ]. Based on multiple studies, including Qatar’s, healthcare providers often feel that no one single individual can address the incorrect prescription of antibiotics, but rather it is a responsibility shared by all [ 20 ]. An increased collective effort supported by national guidelines in conjunction with education will help to reduce the rise of antibiotic misuse and incorrect antibiotic prescription [ 26 ].…”