Challenges in Implementing Antimicrobial Stewardship Programmes at Secondary Level Hospitals in India: An Exploratory...

Area of Science:

• Healthcare Management
• Infectious Disease Control
• Public Health

Background:

• Antimicrobial Stewardship (AMS) programs are vital for combating antibiotic resistance.
• Implementing AMS in secondary hospitals in Low-Middle Income Countries (LMICs) presents unique challenges.
• Understanding these challenges is key to developing effective, context-specific AMS initiatives.

Purpose of the Study:

• To explore the experiences and challenges of implementing AMS programs in secondary level hospitals in Kerala, India.
• To identify factors influencing antibiotic use and selection in these settings.
• To inform the development of sustainable AMS strategies for resource-limited environments.

Main Methods:

• A qualitative study design was employed.
• Semi-structured interviews were conducted with nodal officers at secondary level hospitals.
• Content analysis of transcribed interviews was performed using NVivo 11.0 software.

Main Results:

• Physician and patient factors, including perceived patient satisfaction and patient demographics, influence antibiotic use.
• Physician-related factors such as empiric treatment needs, knowledge gaps, and fear of litigation impact prescribing.
• Hospital-level factors like company promotions and financial reliance on antibiotics affect prescribing patterns.
• Challenges to sustainable AMS include inter-physician competition, time constraints, lack of champions, poor interdepartmental cooperation, inadequate facilities, regulatory issues, and unreliable antibiograms.

Conclusions:

• Implementing sustainable AMS programs in LMIC secondary hospitals is complex and multifactorial.
• Addressing challenges related to financing, technology access, and capacity building is essential.
• Adapting existing AMS models and leveraging international partnerships are crucial for success in resource-limited settings.