A systems thinking approach for antimicrobial stewardship in primary care

Area of Science:

• Public Health
• Health Systems Research
• Infectious Disease Management

Background:

• Antimicrobial resistance (AMR) necessitates robust antimicrobial stewardship (AMS) programs.
• Primary care settings are crucial for reducing overall antimicrobial use.
• Existing AMS strategies are known, but implementation in primary care faces significant, under-researched challenges.

Purpose of the Study:

• To highlight the importance of systems thinking for establishing and facilitating AMS programs in primary care.
• To identify key health system components impacting AMS program implementation.
• To propose tools for optimizing AMS program design and execution.

Main Methods:

• This perspective piece utilizes systems thinking principles.
• It reviews challenges in primary care AMS implementation.
• It proposes the use of a systemigram as a visual tool.

Main Results:

• Primary care AMS implementation is hindered by multifactorial issues including resources, team composition, and system structures.
• Systems thinking offers a framework to understand and address these implementation barriers.
• A systemigram can visually represent system architecture to guide AMS program development.

Conclusions:

• Effective AMS in primary care requires a systems approach, moving beyond known strategies.
• Understanding system dynamics, resources, and interprofessional connections is vital.
• Systems thinking and tools like systemigrams can foster successful primary care AMS programs.