Antibiotic optimisation in 'the bush': Local know-how and core-periphery relations

Area of Science:

• Medical Science
• Public Health
• Sociology of Health

Background:

• Global concern over antimicrobial misuse and resistance is increasing.
• Antibiotic optimization strategies are primarily studied in urban settings.
• Rural and remote hospital contexts for antibiotic stewardship remain under-explored.

Purpose of the Study:

• To investigate the unique dynamics of antibiotic optimization in a remote Australian hospital.
• To understand how the specific setting influences antimicrobial prescribing and stewardship.
• To explore the impact of geographical and knowledge peripheries on antimicrobial practices.

Main Methods:

• Qualitative study design.
• Conducted 30 in-depth interviews with healthcare professionals (doctors, nurses, pharmacists).
• Focus on experiences within a remote Australian hospital setting.

Main Results:

• Antimicrobial practice is significantly shaped by the experience of geographical isolation.
• Healthcare professionals in remote settings often feel at the periphery of established medical knowledge.
• Setting-specific factors are crucial for contextualizing and achieving effective antibiotic optimization.

Conclusions:

• Understanding the influence of locale and periphery is essential for successful antibiotic stewardship in rural areas.
• Future antibiotic optimization initiatives must consider the unique challenges and perspectives of remote healthcare settings.
• The findings contribute to a more nuanced understanding of antimicrobial use in diverse healthcare environments.