Inclusion, diversity, access, and equity in antimicrobial stewardship: where we are and where we are headed

Abstract

Purpose of review This review summarizes existing data on health inequities in antimicrobial stewardship, identifies data gaps and barriers, and reflects on mitigating factors for achieving inclusion, diversity, access, and equity in antimicrobial stewardship. Recent findings Studies show variable antimicrobial prescribing patterns and adverse events according to race/ethnicity, rurality, socioeconomic status, and other factors. Most studies demonstrating these inequities typically do not address their upstream drivers or interventions to mitigate them. Summary Approaching antimicrobial stewardship through a lens of equity can allow antimicrobial stewardship programs (ASPs) opportunities to reach a wider population, and in doing so reduce health inequities. These opportunities include expanding ASPs beyond highly resourced institutions, educational outreach efforts, equity monitoring tools, incentivized equity metrics, and leadership diversification. Clinical research in this area also needs to address drivers of inequities and innovative approaches to mitigating and reducing them.

Prioritizing Equity in Antimicrobial Stewardship Efforts (EASE): a framework for infectious diseases clinicians

“…17 Nonetheless, there is an ever-present opportunity for re-examining equity in institutional AS activities as various studies have described the association between health-related social needs and deleterious infectious disease (ID)-related outcomes observed across minoritized groups. 18 Individuals who reside in areas of low SES reportedly have less access to adequate education opportunities. 19,20 Thus, these groups are more likely to have basic or below basic health literacy when compared to those individuals residing in areas of higher SES.…”

“…11 Reimagining AS through an equity lens, as described by Cichon et al, involves enhancing access to AS, reducing prescribing disparities, launching targeted public health campaigns, and ensuring representation in decision-making. 18 Globally and nationally, healthcare governing agencies such as the World Health Organization (WHO) and the CDC have declared health an essential human right. 12,29 Thus, the conceptual framework for action on the social determinants of health (CSDH) and the Healthy People 2030 framework developed by WHO and the CDC, respectively are well positioned as helpful aids for clinicians to utilize in systematically identifying health-related social needs.…”

“… 17 Nonetheless, there is an ever-present opportunity for re-examining equity in institutional AS activities as various studies have described the association between health-related social needs and deleterious infectious disease (ID)-related outcomes observed across minoritized groups. 18 …”

“… 11 Reimagining AS through an equity lens, as described by Cichon et al, involves enhancing access to AS, reducing prescribing disparities, launching targeted public health campaigns, and ensuring representation in decision-making. 18 …”