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Mandatory antimicrobial stewardship (AMS) programs in China show common strategies but lead to unintended consequences. Key barriers include poor communication and profit-driven systems, hindering effective AMS implementation.

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Area of Science:

  • Healthcare Management
  • Infectious Disease Control
  • Public Health Policy

Background:

  • Antimicrobial resistance necessitates robust antimicrobial stewardship (AMS) programs.
  • China's healthcare system faces unique challenges in implementing mandatory AMS programs.

Purpose of the Study:

  • To investigate the implementation strategies of mandatory AMS programs in China.
  • To identify unintended consequences and barriers associated with these programs.
  • To provide recommendations for improving AMS program effectiveness.

Main Methods:

  • Qualitative study employing face-to-face, in-depth interviews.
  • 111 respondents interviewed across 16 public hospitals in diverse regions of China.
  • Thematic framework analysis used to analyze interview data.

Main Results:

  • A common implementation strategy involves hospital leadership empowering AMS teams and setting performance indicators.
  • Unintended consequences include regulatory circumvention, risk shifting to clinicians and patients, and healthcare worker demotivation.
  • Key barriers are poor communication between AMS teams and doctors and a profit-driven compensation system.

Conclusions:

  • Mandatory AMS programs require enhanced training, improved communication, and adjusted compensation systems.
  • Addressing power dynamics and financial incentives is crucial for successful AMS implementation.
  • Supportive measures are needed to facilitate the adoption of strict AMS regulations.