Sunshine Coast Hospital and Health Service, University of Queensland, 6 Doherty Street, Birtinya, Australia.
Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.
J Hosp Infect. 2018 Nov;100(3):265-269. doi: 10.1016/j.jhin.2018.06.002. Epub 2018 Jun 8.
Antibiotic optimization is an urgent international issue. Regulatory frameworks, including the requirement to have a functioning antimicrobial stewardship (AMS) programme, are now ubiquitous across the hospital sector nationally and internationally. However, healthcare is ultimately delivered in a diverse range of institutional settings and social contexts. There is emerging evidence that implementation of antibiotic optimization strategies may be inappropriate or even counterproductive to attempts to optimize in atypical healthcare settings.
To document the experiences and perspectives of clinical staff in a remote healthcare setting in Australia with respect to antimicrobial use, and strategies for optimization in that environment.
Semi-structured qualitative interviews were conducted with 30 healthcare professionals, including doctors, nurses and pharmacists, from a remote hospital in Queensland, Australia.
Four themes were identified from the analysis as key challenges to antibiotic optimization: (i) AMS as externally driven, and local knowledge sidelined; (ii) perceptions of heightened local population risks, treatment failure and the subsequent pressure to over-use of antimicrobials; (iii) interprofessional relationship dynamics including medical hierarchical structures perceived as a barrier to AMS; (iv) a clinical workforce dominated by transient locum staff and other process issues were perceived as significant barriers.
The perceptions of healthcare professionals in this site lead to the conclusion that antimicrobial regulations and practice improvement strategies more generally are unlikely to succeed if they fail to accommodate and respect the context of care, the resource and structural constraints of the setting, and the specificities of particular populations (and subsequent clinical 'know-how').
抗生素优化是一个紧迫的国际问题。监管框架，包括要求有一个运作良好的抗菌药物管理（AMS）计划，现在在全国和国际上的医院部门无处不在。然而，医疗保健最终是在各种不同的机构环境和社会背景下提供的。有新的证据表明，在非典型医疗环境中实施抗生素优化策略可能不恰当，甚至可能对优化尝试产生反效果。
记录澳大利亚偏远地区医疗机构的临床工作人员在使用抗生素方面的经验和观点，以及在该环境中优化抗生素的策略。
对来自澳大利亚昆士兰州一家偏远医院的 30 名医疗保健专业人员（包括医生、护士和药剂师）进行了半结构化的定性访谈。
从分析中确定了四个主题，这些主题是抗生素优化的关键挑战：（i）AMS 是外部驱动的，而本地知识被忽视；（ii）对当地人群风险、治疗失败的看法以及随后过度使用抗生素的压力；（iii）包括医疗等级结构在内的专业间关系动态，被认为是 AMS 的障碍；（iv）以临时驻场工作人员为主的临床劳动力和其他流程问题被认为是重大障碍。
该地点的医疗保健专业人员的看法得出结论，如果抗生素法规和实践改进策略不能适应和尊重护理环境、设置的资源和结构限制以及特定人群（和随后的临床“诀窍”）的特殊性，那么这些策略不太可能成功。
