| Περίληψη: | <p>Antimicrobial resistance (AMR) is an accelerating public health problem, with antimicrobial agents, including their inappropriate use, being one of the key drivers. In Indonesian hospitals, there is a fragmented picture of antibiotic use and of the drivers of prescribing patterns. This thesis aimed to fill this knowledge gap by assessing patterns and quality indicators of antibiotic prescribing for hospitalised patients, mapping their drivers and dynamics, and exploring the factors influencing the implementation of antimicrobial stewardship (AMS) programmes.</p>
<p>Using an explanatory sequential mixed-method approach, data collection was conducted in six hospitals in Jakarta, between March 2019 and October 2020.</p>
<p>A quantitative survey found high proportions of hospitalised patients receiving systemic antibiotics, that guideline compliance was poor, use of blood cultures was low, and that prolonged surgical prophylaxis was common.</p>
<p>The qualitative findings revealed multidimensional social-cultural factors influenced antibiotic prescribing, such as disjunctions between drivers of AMR and day-to-day clinical practice, antibiotic prescribing as risk aversion vis-à-vis concerns of poor clinical outcomes, the ‘pull’ of conformity to normative, suboptimal group prescribing practices, and suboptimal operations of microbiology and surgical facilities. Effective AMS programme implementation was challenged by ineffective resourcing and institutional buy-in, cost-prohibitive culture testing, entangled hospital priorities to generate profits, and a non-collegial communication approach to AMS execution.</p>
<p>Three identified areas of improvement are addressing hierarchical cultural norms in the medical profession, encouraging ownership of the AMR problem and solution among all stakeholders, and developing sustainable context-specific AMS strategies. Based on the complex adaptive system (CAS) concept, I formulated four recommendations: 1) identifying the agents of influence; 2) evaluating the problem using a CAS lens; 3) developing health system resilience; and 4) identifying leverage points.</p>
<p>In conclusion, this thesis contributed to the development of a conceptual framework showing how multilevel and multidimensional social-cultural factors interact to influence antibiotic prescribing and AMS implementation.</p>
|
|---|