Antimicrobial Stewardship Programs in Health Facilities: A Behavioural Science Approach
Antimicrobial Stewardship Programs in Health Facilities: A Behavioural Science Approach
Year: October 2022
Collaborator: Pfizer
Team: Sarang Deo, Ashish Sachdeva, Samayita Ghosh, Deepali Verma
Background
Antimicrobial Resistance (AMR) is a huge public health threat, with 1.27 million deaths attributed to it globally. The unregulated use of antimicrobials exacerbates the crisis. One of the five key objectives laid out in the Global Action plan on AMR emphasises the need to regulate and optimize the use of antimicrobials. In this context, Antimicrobial Stewardship (AMS) offers a structured and coherent action plan which ensures the responsible use of antimicrobials. India’s National Action Plan on Antimicrobial Resistance (NAP-AMR) also incorporates AMS as a crucial step to curb the misuse of antimicrobials. It is important to note that the success of AMS relies on integrating key elements like leadership, accountability, and effective tracking systems in healthcare facilities.
About the Study
While most studies globally have focussed on clinical aspects related to AMR and their evaluation, the dynamic context-specific processes and behavioural aspects associated with it in healthcare settings are less understood. This study was conducted to examine the factors that influence the success and failure of intervention strategies designed to facilitate the implementation of an antimicrobial stewardship (AMS) program in healthcare facilities.
Methodology
The study used an explorative qualitative design using a semi-structured interview methodology to understand current antimicrobial stewardship (AMS) practices in large and medium chain hospitals, as well as small independent hospitals across several tier 1, 2, and 3 cities in India. In-depth semi structured interviews were conducted with healthcare providers in selected healthcare setups.
Key Recommendations
The findings focussed on hospital staff behaviours, highlighting adaptable, evidence-based strategies to enhance prescribing practices throughout the continuum of care across hospitals of all sizes.
- AMS Expertise: Large hospitals have established AMS programs with protocols and checks. Smaller hospitals can hire or identify AMS champions to guide their efforts.
- Role Clarity: Clarity in roles is crucial. Larger hospitals can enhance AMS by expanding existing roles, while smaller hospitals need a strong leadership-driven system with a consultative approach.
- Four Moments Framework: Implement a contextualized Four Moments Framework for antimicrobial prescribing, including pauses for assessment, culture selection, de-escalation and treatment duration, supported by localized guidelines.
- Accessible Interventions: Use cost-effective, comprehensible intervention strategies based on global behavioural approaches, tailored for each hospital’s AMS program.