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

Lianne Jeffs,Andrew Morris,Michelle Zahradnik,Arrani Senthinathan,Linda Dresser,Chaim Bell,David Tannenbaum,Mark Mcintyre,Warren Mcisaac,Enrique Castro-Sánchez

doi:10.1371/journal.pone.0223822

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.

Highlights

Qualitative interviews were conducted with primary care clinicians, including local Antimicrobial Stewardship Programs (ASPs) champions, prescribers, and other primary health care team members, while they participated in an ASP initiative
The narrative dataset yielded a number of themes that could be considered broadly as those facilitating involvement in ASP activities in the primary care setting, and factors that were seen as barriers to optimal antimicrobial prescribing
This theme reflected how local champions were perceived by study participants in influencing them to participate in the Primary Care Antimicrobial Stewardship Program (PC-ASP)

Summary

Introduction

Antimicrobial resistance (AMR) is a complex global public health threat, [1,2] and is strongly associated with antimicrobial consumption. [3,4] It is estimated that three-quarters of antimicrobial use occurs in the community, where primary care practitioners account for the bulk of antimicrobial prescribing. [1,5,6] These outpatient antimicrobial prescriptions are most often issued for upper and lower respiratory conditions including sinusitis, otitis media, pharyngitis, acute bronchitis and pneumonia. [5,6,7] up to 50% of these prescriptions may be unnecessary or inappropriate.

Methods

Results

Discussion

Conclusion