Remote realities: In-depth conversations on antimicrobial stewardship in remote Indigenous communities using a One Health approach.
This study highlights the importance of understanding social determinants in antimicrobial stewardship within remote Indigenous communities. Collaboration across disciplines is essential for improving antimicrobial practices.
Where it sits
this study against the rest of the snap-8 corpusSummary and findings
This study explored antimicrobial stewardship (AMS) and antimicrobial resistance (AMR) in remote Indigenous communities through in-depth interviews with fourteen participants, including healthcare professionals. Factors influencing antimicrobial use and health systems were examined, with a focus on social determinants of health. Staff shortages and high workload were identified as challenges affecting AMS.
Abstract
A One Health approach encourages transdisciplinarity and equity when working to optimise the health of people, animals and the environment. It is helpful to use a One Health approach to explore issues such as antimicrobial resistance (AMR), where a traditionally medicalised focus may otherwise prevent investigation or understanding of lesser known but still relevant influences. In-depth interviews with fourteen participants (nurses, doctors, Aboriginal health workers, veterinarians and antimicrobial stewardship (AMS) pharmacists) were conducted to explore under-investigated topics of AMR and AMS in remote communities as they relate to medical and veterinary practice. We aimed to explore the relationships between factors influencing antimicrobial use and health systems, such as the social determinants of health. Staff shortages and high workload were identified as factors that influenced AMS and the capacity of prescribers to make more appropriate antimicrobial choices. Generally low antimicrobial use in remote community veterinary practice was identified, however veterinary surgical prophylaxis is an area where the quality of prescribing could be improved. Other enablers for AMS include the positive influence of local Aboriginal health practitioners and their equivalents in animal health, openness by participants to improve their practices, and evidence amongst participants of understanding or acknowledgement of upstream drivers of AMR and interest in working collaboratively across disciplines.
Background
This paper addresses the intersection of antimicrobial stewardship and antimicrobial resistance within remote Indigenous communities, an area that has received limited attention. Prior research has often focused on medicalized perspectives, potentially overlooking important social and environmental factors. Understanding these dynamics is crucial for developing effective strategies to combat AMR in these communities.
Methods
The study utilized a qualitative design, conducting in-depth interviews with fourteen participants from various professional backgrounds, including healthcare and veterinary fields. The aim was to investigate the influences on antimicrobial use and AMS practices in remote settings. Specific details on the interview duration, frequency, or structured protocols were not reported in abstract.
Results
The study found that staff shortages and high workloads significantly influenced AMS and the ability of prescribers to make informed antimicrobial choices. Participants acknowledged the generally low antimicrobial use in veterinary practice, with specific mention of the need for improved prescribing in surgical prophylaxis. No quantitative data on antimicrobial use rates or prescribing practices were provided.
Interpretation
The findings align with existing literature highlighting the complexity of AMS in remote communities, suggesting that while there is awareness of AMR issues, practical challenges remain. The effect sizes related to prescribing practices were not quantified, limiting the ability to assess clinical significance. Confounding factors include the small sample size and qualitative nature of the study, which may not reflect broader trends.
Key findings
- Fourteen participants included nurses, doctors, Aboriginal health workers, veterinarians, and AMS pharmacists.
- Generally low antimicrobial use in remote community veterinary practice was identified.
- Veterinary surgical prophylaxis was noted as an area for improvement in prescribing quality.
Limitations
- Qualitative study with small n=14.
- Limited generalizability due to the specific context of remote Indigenous communities.
- No quantitative data on antimicrobial use rates provided.