Gaps and barriers in the implementation and functioning of antimicrobial stewardship programmes: Results from an educational and behavioural mixed methods needs assessment in France, the United States, Mexico and India

Autores organización

• 

  Maria Virginia Villegas Botero

  Autor

  mvvillegas@unbosque.edu.co

Autores

• Lazure P.
• Augustyniak M.
• Goff D.A.
• Apisarnthanarak A.
• Peloquin S.

Grupos de investigación

• Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria RAEH

  

  Investigador

  Maria Virginia Villegas Botero

  mvvillegas@unbosque.edu.co

Resumen

Background: Evidence shows limited adherence to antimicrobial stewardship (AMS) principles. Objectives: To identify educational gaps and systemic barriers obstructing adherence to AMS principles. Methods: A mixed-methods study combining a thematic analysis of qualitative interviews (January-February 2021) and inferential analysis of quantitative surveys (May-June 2021) was conducted. Participants from France, the USA, Mexico and India were purposively sampled from online panels of healthcare professionals to include infectious disease physicians, infection control specialists, clinical microbiologists, pharmacologists or pharmacists expected to apply AMS principles in their practice setting (e.g. clinic, academic-affiliated or community-based hospital). A gap analysis framework guided this study. Results: The final sample included 383 participants (n = 33 interviews; n = 350 surveys). Mixed-methods findings indicated suboptimal knowledge and skills amongst participants to facilitate personal and collective application of AMS principles. Survey data indicated a gap in ideal versus current knowledge of AMS protocols, especially amongst pharmacologists ( 0.95/4.00, P < 0.001). Gaps in ideal versus current skill levels were also measured and were highest amongst infectious control specialists ( 1.15/4.00, P < 0.001), for convincing hospital executives to allocate resources to AMS programmes. Already existing systemic barriers (e.g. insufficient dedicated time/funding/training) were perceived as being aggravated during the COVID-19 pandemic (72% of survey participants agreed). Reported gaps were highest in India and France. Conclusions: The educational needs of professionals and countries included in this study can inform future continuous professional development activities in AMS. Additional funding should be considered to address perceived systemic barriers. Local assessments are warranted to validate results and suitability of interventions. © 2022 The Author(s). Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.

Keywords

• adult; antimicrobial stewardship; Article; clinical pharmacist; clinical protocol; coronavirus disease 2019; education program; female; France; funding; health care personnel; human; India; infection control practitioner; interview; knowledge; major clinical study; male; medical specialist; Mexico; microbiologist; needs assessment; pandemic; pharmacologist; physician; purposive sample; qualitative research; quantitative analysis; skill; thematic analysis; time; United States