Remote realities: In-depth conversations on antimicrobial stewardship in remote Indigenous communities using a One...

Area of Science:

• Public Health
• Veterinary Medicine
• Environmental Health

Background:

• A One Health approach integrates human, animal, and environmental health to address complex issues like antimicrobial resistance (AMR).
• Traditional medical focus may limit understanding of AMR influences, necessitating broader perspectives.
• Remote communities face unique challenges in managing AMR and antimicrobial stewardship (AMS).

Purpose of the Study:

• To explore under-investigated aspects of AMR and AMS in remote settings through a One Health lens.
• To investigate factors influencing antimicrobial use and health systems, including social determinants.
• To understand the interplay between medical and veterinary practices concerning AMR and AMS.

Main Methods:

• Conducted in-depth interviews with 14 participants: nurses, doctors, Aboriginal health workers, veterinarians, and AMS pharmacists.
• Explored perceptions of AMR, AMS, and influencing factors in remote community practices.
• Focused on relationships between antimicrobial use, health systems, and social determinants.

Main Results:

• Staff shortages and high workloads negatively impact AMS and appropriate prescribing.
• Veterinary antimicrobial use is generally low, but surgical prophylaxis requires improved prescribing quality.
• Positive influences on AMS include Aboriginal health practitioners, openness to improvement, and understanding of AMR drivers.

Conclusions:

• A One Health framework is valuable for addressing AMR and AMS in remote communities.
• Addressing social determinants and system factors like staffing is essential for effective AMS.
• Interdisciplinary collaboration, particularly with Aboriginal health workers, can enhance AMR and AMS strategies.