Wang Xiaomin, Lin Leesa, Xu Xin, Harbarth Stephan, Yakob Laith, Zhang Ran, Zhou Xudong
School of Public Administration, Hangzhou Normal University, No. 2318 Yuhangtang Road, Yuhang District, Hangzhou 311121, China.
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
Health Policy Plan. 2025 Jun 12;40(6):591-599. doi: 10.1093/heapol/czaf019.
This study aims to investigate the implementation strategy, unintended consequences, and underlying barriers to mandatory antimicrobial stewardship (AMS) programs in China. Face-to-face, in-depth qualitative interviews were conducted in 16 public hospitals in eastern, central, and western China. Hospitals were purposely selected with full consideration to represent both economically developing and developed areas and both secondary and tertiary care hospitals. A total of 111 respondents were interviewed, including 38 doctors, 28 clinical pharmacists, 15 microbiologists, 14 infection prevention and control specialists, 10 experts from medical service departments, and 6 quality improvement experts. A thematic framework analysis was conducted. A common implementation strategy was found among the surveyed hospitals in response to the AMS programs mandated by healthcare authorities. The hospital leadership empowered an AMS team to set AMS-related indicators for each clinical department and each doctor, and adopted core elements of AMS to optimize antimicrobial prescribing. However, the mandatory AMS approach also caused unintended consequences including regulatory circumvention, shift of risk to doctors and patients, and demotivation of healthcare workers. Two key barriers to AMS implementation were identified: (i) poor communication and cooperation between the AMS team and doctors, characterized by a high-power-low-power dynamic within hospital disciplines; and (ii) the profit-driven compensation system, which discourages collaboration and resource distribution for AMS implementation. Mandatory AMS programs should intensify AMS training, promote communication and cooperation between the AMS team and doctors, adjust the compensation system to facilitate better AMS implementation, and offer supportive measures that enable the adoption of strict regulations.
本研究旨在调查中国强制性抗菌药物管理（AMS）项目的实施策略、意外后果及潜在障碍。在中国东部、中部和西部的16家公立医院进行了面对面的深入定性访谈。医院的选取经过了精心考虑，以充分代表经济发展地区和发达地区以及二级和三级医疗机构。共访谈了111名受访者，包括38名医生、28名临床药师、15名微生物学家、14名感染预防与控制专家、10名医疗服务部门专家以及6名质量改进专家。进行了主题框架分析。在接受调查的医院中发现了一种针对卫生当局强制推行的AMS项目的常见实施策略。医院领导授权一个AMS团队为每个临床科室和每位医生设定与AMS相关的指标，并采用AMS的核心要素来优化抗菌药物处方。然而，强制性AMS方法也导致了意外后果，包括规避监管、将风险转移给医生和患者以及医护人员积极性受挫。确定了AMS实施的两个关键障碍：（i）AMS团队与医生之间沟通与合作不佳，其特点是医院各学科内部存在高权力-低权力动态；（ii）利润驱动的薪酬体系，这不利于AMS实施的协作和资源分配。强制性AMS项目应加强AMS培训，促进AMS团队与医生之间的沟通与合作，调整薪酬体系以促进更好地实施AMS，并提供支持措施以确保严格规定的采用。
