Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa
Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-01-01
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| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/10/1/94 |
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| author | Carolyn Tarrant Andrew M. Colman David R. Jenkins Edmund Chattoe-Brown Nelun Perera Shaheen Mehtar W.M.I. Dilini Nakkawita Michele Bolscher Eva M. Krockow |
| author_facet | Carolyn Tarrant Andrew M. Colman David R. Jenkins Edmund Chattoe-Brown Nelun Perera Shaheen Mehtar W.M.I. Dilini Nakkawita Michele Bolscher Eva M. Krockow |
| author_sort | Carolyn Tarrant |
| collection | DOAJ |
| description | Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions. |
| first_indexed | 2024-03-09T04:19:48Z |
| format | Article |
| id | doaj.art-134d878b062141b8ac6598d3c46afa32 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T04:19:48Z |
| publishDate | 2021-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-134d878b062141b8ac6598d3c46afa322023-12-03T13:48:45ZengMDPI AGAntibiotics2079-63822021-01-011019410.3390/antibiotics10010094Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South AfricaCarolyn Tarrant0Andrew M. Colman1David R. Jenkins2Edmund Chattoe-Brown3Nelun Perera4Shaheen Mehtar5W.M.I. Dilini Nakkawita6Michele Bolscher7Eva M. Krockow8Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UKDepartment of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7RH, UKDepartment of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UKSchool of Media, Communication and Sociology, University of Leicester, Leicester LE1 7JA, UKDepartment of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UKTygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town 7505, South AfricaDepartment of Clinical Microbiology, Faculty of Medicine, General Sir John Kotelawala Defence University, Dehiwala-Mount Lavinia 10390, Sri LankaTygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town 7505, South AfricaDepartment of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7RH, UKAntimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.https://www.mdpi.com/2079-6382/10/1/94antimicrobial stewardshipantibacterial agentshospitalsphysiciansdecision makingqualitative methods |
| spellingShingle | Carolyn Tarrant Andrew M. Colman David R. Jenkins Edmund Chattoe-Brown Nelun Perera Shaheen Mehtar W.M.I. Dilini Nakkawita Michele Bolscher Eva M. Krockow Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa Antibiotics antimicrobial stewardship antibacterial agents hospitals physicians decision making qualitative methods |
| title | Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa |
| title_full | Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa |
| title_fullStr | Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa |
| title_full_unstemmed | Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa |
| title_short | Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa |
| title_sort | drivers of broad spectrum antibiotic overuse across diverse hospital contexts a qualitative study of prescribers in the uk sri lanka and south africa |
| topic | antimicrobial stewardship antibacterial agents hospitals physicians decision making qualitative methods |
| url | https://www.mdpi.com/2079-6382/10/1/94 |
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