Tenner Rebecca A, Grussing Emily D, Manning David, Ngassa Yvane, van den Berg Jacob J, Vazquez Gabriela Andujar, Doron Shira, Campion Maureen, Wurcel Alysse G
Division of Geographic Medicine and Infectious Disease, Department of Medicine, Tufts Medical Center, Boston, MA, USA.
School of Arts and Sciences, Tufts University, Medford, MA, USA.
BMC Glob Public Health. 2024 Aug 26;2(1):59. doi: 10.1186/s44263-024-00090-1.
Widespread antibiotic prescribing contributes to globally emerging antimicrobial resistance (AMR). Despite stewardship recommendations by the Infectious Diseases Society of America, there is a lack of literature identifying barriers and facilitators to antimicrobial stewardship programs (ASPs) in United States (U.S.) carceral settings.
Guided by the Theoretic Domains Framework, we performed in-depth interviews with 68 key stakeholders in Massachusetts carceral settings to contextualize barriers and facilitators to ASP implementation. We recruited 32 people incarcerated in Massachusetts jails and 36 carceral clinicians, correctional officers/administrators in Massachusetts and other U.S. states, and Massachusetts community clinicians for interviews.
From the completed semi-structured in-depth interviews, we identified seven salient themes-four barriers and three facilitators-both specific to and across stakeholder groups. Barriers included the following: (1) jail being viewed as a "dirty place" that increases the risk of infections; (2) variable awareness and knowledge of AMR and ASPs; (3) clinicians' opposition to change and oversight of their antibiotic prescribing; (4) competing priorities taking precedence over ASP implementation. Facilitators included (5) interest in changing the narrative about carceral healthcare through ASP implementation; (6) opportunities for education about ASP and AMR; and (7) the development of systems, policies, and regulations to improve antibiotic prescribing.
To our knowledge, this is the first qualitative study to leverage broad criminal-legal stakeholder groups to inform the next steps in developing and implementing ASPs in carceral settings in the U.S.
广泛使用抗生素导致全球范围内出现抗菌药物耐药性（AMR）。尽管美国传染病学会提出了管理建议，但在美国监狱环境中，缺乏关于确定抗菌药物管理计划（ASP）的障碍和促进因素的文献。
在理论领域框架的指导下，我们对马萨诸塞州监狱环境中的68名关键利益相关者进行了深入访谈，以了解ASP实施的障碍和促进因素。我们招募了32名被关押在马萨诸塞州监狱的人员以及36名监狱临床医生、马萨诸塞州和美国其他州的惩教官员/管理人员以及马萨诸塞州社区临床医生进行访谈。
通过完成的半结构化深入访谈，我们确定了七个突出主题——四个障碍和三个促进因素——这些主题既特定于利益相关者群体，又跨越这些群体。障碍包括：（1）监狱被视为增加感染风险的“脏地方”；（2）对抗菌药物耐药性和抗菌药物管理计划的认识和知识参差不齐；（3）临床医生反对改变以及对其抗生素处方的监督；（4）相互竞争的优先事项优先于抗菌药物管理计划的实施。促进因素包括：（5）有兴趣通过实施抗菌药物管理计划来改变对监狱医疗保健的看法；（6）有机会接受关于抗菌药物管理计划和抗菌药物耐药性的教育；（7）制定系统、政策和法规以改善抗生素处方。
据我们所知，这是第一项利用广泛的刑事法律利益相关者群体来为美国监狱环境中制定和实施抗菌药物管理计划的下一步提供信息的定性研究。
