Factors Influencing the Implementation of Antimicrobial Stewardship in Primary Care: A Narrative Review

Area of Science:

• Public Health
• Infectious Diseases
• Health Services Research

Background:

• Antimicrobial resistance (AMR) is a significant global health threat, primarily driven by inappropriate antibiotic use.
• Primary care settings account for the majority of antibiotic consumption, yet antimicrobial stewardship (AMS) activities are underdeveloped.
• Understanding factors influencing AMS implementation in primary care is crucial for its real-world impact.

Purpose of the Study:

• To review and summarize literature on AMS interventions in primary care.
• To identify and analyze individual and contextual factors affecting AMS implementation in primary care.

Main Methods:

• A narrative review of peer-reviewed literature was conducted.
• The review focused on studies reporting on AMS interventions and their implementation in primary care settings.

Main Results:

• AMS activities were reported at individual, collective, and policy levels, often in combination, making standalone evaluation difficult.
• Key factors identified include challenges in physician engagement, the need for flexible interventions due to tight workflows, and potential for AMS to enhance patient relationships.
• A significant lack of information exists regarding factors that support or hinder AMS implementation in primary care.

Conclusions:

• Effective AMS in primary care requires a deeper understanding of multilevel barriers and facilitators.
• Further research is essential to identify and address these factors before widespread implementation of primary care AMS interventions.