National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Vic. 3000, Australia. Email:
Aust Health Rev. 2020 Jun;44(3):415-420. doi: 10.1071/AH19097.
Objective The aim of this study was to explore the features of sustainable antimicrobial stewardship (AMS) programs in Australian rural hospitals and develop recommendations on incorporating these features into rural hospitals' AMS programs. Methods Lead AMS clinicians with knowledge of at least one AMS program sustained for >2 years in a health service in rural Australia were recruited to the study. A series of interviews was conducted and the transcripts analysed thematically using a framework method. Results Fifteen participants from various professional disciplines were interviewed. Key features that positively affected the sustainability of AMS programs in rural hospitals included a hospital executive who provided strong governance and accountability, dedicated resources, passionate local champions, area-wide arrangements and adaptability to engage in new partnerships. Challenges to building AMS programs with these features were identified, particularly in engaging hospital executive to allocate AMS resources, managing the burn out of passionate champions and formalising network arrangements. Conclusions Strategies to increase the sustainability of AMS programs in rural hospitals include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop formal network arrangements and a framework for integrated AMS programs across primary, aged and acute care. What is known about the topic? AMS programs facilitate the responsible use of antimicrobials. Implementation challenges have been identified for rural hospitals, but the sustainability of AMS programs has not been explored. What does this paper add? Factors that positively affected the sustainability of AMS programs in rural hospitals were a hospital executive that provided strong governance and accountability, dedicated resources, network or area-wide arrangements and adaptability. Challenges to building AMS programs with these features were identified. What are the implications for practitioners? Recommended actions to boost the sustainability of AMS programs in rural hospitals are required. These include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop network arrangements and support to create integrated AMS programs across acute, aged and primary care.
目的 本研究旨在探讨澳大利亚农村医院可持续抗菌药物管理（AMS）计划的特点，并就将这些特点纳入农村医院 AMS 计划提出建议。
方法 招募了在澳大利亚农村卫生服务机构中具有至少 2 年以上知识的首席 AMS 临床医生参与研究。对他们进行了一系列访谈，并使用框架方法对转录本进行了主题分析。
结果 来自各种专业学科的 15 名参与者接受了访谈。对农村医院 AMS 计划的可持续性产生积极影响的关键特征包括提供强有力的治理和问责制的医院行政人员、专用资源、充满激情的本地拥护者、区域范围的安排和适应能力以建立新的伙伴关系。在构建具有这些特征的 AMS 计划方面遇到的挑战包括，让医院行政人员分配 AMS 资源、管理充满激情的拥护者的倦怠以及使网络安排正式化。
结论 增加农村医院 AMS 计划可持续性的策略包括利用认证作为驱动直接资源分配的机制、为农村医院提供明确的人员配备建议、为制定正式网络安排提供更大支持以及为初级、老年和急性护理的综合 AMS 计划提供框架。
关于该主题已知的内容是什么？AMS 计划促进了对抗生素的负责任使用。已经确定了农村医院实施面临的挑战，但尚未探讨 AMS 计划的可持续性。本文增加了什么？对农村医院 AMS 计划的可持续性产生积极影响的因素包括提供强有力的治理和问责制的医院行政人员、专用资源、网络或区域范围的安排以及适应性。确定了构建具有这些特征的 AMS 计划的挑战。
这对从业者意味着什么？需要采取推荐的行动来提高农村医院 AMS 计划的可持续性。这些措施包括利用认证作为推动直接资源配置的机制、为农村医院提供明确的人员配备建议、为制定网络安排提供更多支持以及为创建跨急性、老年和初级保健的综合 AMS 计划提供支持。
