Abstract
BackgroundIrrational use of antibiotics is proving to be a major concern to the health systems globally. This results in antibiotics resistance and increases health care costs. In Iran, despite many years of research, appreciable efforts, and policymaking to avoid irrational use of antibiotics, yet indicators show suboptimal use of antibiotics, pointing to an urgent need for adopting alternative approaches to further understand the problem and to offer new solutions. Applying the Complex Adaptive Systems (CAS) theory, to explore and research health systems and their challenges has become popular. Therefore, this study aimed to better understand the complexity of the irrational use of antibiotics in Iran and to propose potential solutions.MethodThis research utilized a CAS observatory tool to qualitatively collect and analyse data. Twenty interviews and two Focus Group discussions were conducted. The data was enriched with policy document reviews to fully understand the system. MAXQDA software was used to organize and analyze the data.ResultWe could identify several diverse and heterogeneous, yet highly interdependent agents operating at different levels in the antibiotics use system in Iran. The network structure and its adaptive emergent behavior, information flow, governing rules, feedback and values of the system, and the way they interact were identified. The findings described antibiotics use as emergent behavior that is formed by an interplay of many factors and agents over time. According to this study, insufficient and ineffective interaction and information flow regarding antibiotics between agents are among key causes of irrational antibiotics use in Iran. Results showed that effective rules to minimize irrational use of antibiotics are missing or can be easily disobeyed. The gaps and weaknesses of the system which need redesigning or modification were recognized as well.ConclusionThe study suggests re-engineering the system by implementing several system-level changes including establishing strong, timely, and effective interactions between identified stakeholders, which facilitate information flow and provision of on-time feedback, and create win-win rules in a participatory manner with stakeholders and the distributed control system.
Highlights
Irrational use of antibiotics is proving to be a major concern to the health systems globally
Despite all appreciable efforts to promote the rational use of antibiotics in Iran such as establishing the National Committee on Rational Use of Drugs (NCRUD), codifying some regulations and guidelines, educating the public on the rational use of antibiotics, enforcing new pharmaceutical protocols in hospitals to rationalize the use of most expensive antibiotics, and conducting several research studies in this field, indicators continue to show a suboptimal prescription and use of antibiotics in Iran [15, 16]
We first present an overview of the irrational use of antibiotics in Iran and, followed by describing the system as a Complex Adaptive Systems (CAS) using the CAS observatory tool
Summary
Irrational use of antibiotics is proving to be a major concern to the health systems globally This results in antibiotics resistance and increases health care costs. In Iran, despite many years of research, appreciable efforts, and policymaking to avoid irrational use of antibiotics, yet indicators show suboptimal use of antibiotics, pointing to an urgent need for adopting alternative approaches to further understand the problem and to offer new solutions. Despite all appreciable efforts to promote the rational use of antibiotics in Iran such as establishing the National Committee on Rational Use of Drugs (NCRUD), codifying some regulations and guidelines, educating the public on the rational use of antibiotics, enforcing new pharmaceutical protocols in hospitals to rationalize the use of most expensive antibiotics, and conducting several research studies in this field, indicators continue to show a suboptimal prescription and use of antibiotics in Iran [15, 16]. Studies that have explored the current situation of irrational use of antibiotics in Iran, pointed out the insufficiency of previous efforts in improving the status quo and, subsequently, the necessity of a shift in policymaking and defining the problem
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