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Quantitative Polymerase Chain Reaction-based Analyses of Murine Intestinal Microbiota After Oral Antibiotic Treatment
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Do you see the problem? Visualising a generalised 'complex local system' of antibiotic prescribing across the United

Rebecca E Glover1, Nicholas B Mays1, Alec Fraser2

  • 1Policy Innovation Research Unit, London School of Hygiene and Tropical Medicine, London, UK.

Critical Public Health
|November 28, 2023
PubMed

Insights

Antimicrobial resistance (AMR) interventions often fail because they focus on individual prescribers, not the complex local systems. Understanding these systems is key to effective, long-term antibiotic stewardship.

Area of Science:

  • Public Health
  • Health Systems Research
  • Qualitative Research Methods

Background:

  • Antimicrobial resistance (AMR) is a significant global health threat.
  • Current AMR interventions, particularly for antibiotic prescribing, often adopt a narrow focus on individual prescriber behavior.
  • There is a need for a more systemic approach to understand and address antibiotic prescribing patterns.

Purpose of the Study:

  • To explore the complex nature of local antibiotic prescribing systems in the UK.
  • To apply complex systems theory and systems mapping to qualitative data on antibiotic prescribing.
  • To understand the interactions between antibiotic prescribing interventions and the broader health system.

Main Methods:

  • Conducted 71 semi-structured interviews in six diverse UK local areas.
  • Utilized complex systems theory principles.
  • Employed systems mapping techniques for qualitative data analysis.

Main Results:

  • Identified a complex interplay of proximal and distal factors influencing local antibiotic prescribing.
  • Observed that these factors can produce unpredictable effects across different local systems.
  • Highlighted that performance management interventions without contextual understanding lead to temporary fixes and unintended consequences.

Conclusions:

  • Effective antimicrobial resistance (AMR) interventions require a deep understanding of local prescribing system dynamics.
  • Policy makers and researchers should adopt systems-thinking approaches for designing and evaluating AMR strategies.
  • Future interventions must acknowledge and respond to the complex pressures faced by prescribers for sustainable effectiveness.
Keywords:
Antimicrobial resistancecomplex systemprescribing

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