Jennifer Broom is an Infectious Diseases Physician at the Sunshine Coast University Hospital, in QLD, Australia, and an Associate Professor of Medicine at the University of Queensland. She has a research programme in collaboration with the University of Sydney School of Social and Political Sciences which examines the social and behavioural factors that lead to antimicrobial overuse and misuse. This work has led to translational work in which social influences is used in antimicrobial stewardship interventions to optimise antimicrobial use in multiple Australian Hospitals. Jennifer is interested in the way cultures of medicine, and healthcare influence clinical decision-making.
The Social World Of Antimicrobial Use
Significant antimicrobial overuse persists worldwide, despite overwhelming evidence of antimicrobial resistance and knowledge that optimization of antimicrobial use will slow the development of resistance. It is critical to understand why this occurs. Through an in-depth, multisite analysis, the social influences on antimicrobial use within hospitals in Australia were studied. 222 individual semi-structured interviews were performed and thematic
analysis was undertaken. Participants (85 doctors, 79 nurses, 31 pharmacists and 27 hospital managers) were recruited from five hospitals in Australia, including four public hospitals (two metropolitan, one regional and one remote) and one private hospital. Analysis of the interviews identified social relationships and institutional structures that may have a strong influence on antimicrobial use, which must be addressed concurrently.
1. social influences that are pervasive across clinical settings: including the influence of personal risk, hierarchies, inter- and intra-professional dynamics
and sense of futility in making a difference long term in relation to antimicrobial resistance. 2. Institutional structures/environments that offer context-specific influences: these include patient population factors (including socioeconomic factors, geographical isolation and local infection patterns), proximity and resource issues.
Conclusions: The success of antimicrobial optimization rests on adequate awareness and incorporation of multilevel influences. Analysis of the problem has tended to emphasize individual ‘behaviour improvement’ in prescribing rather than incorporating the problem of overuse as inherently multidimensional and necessarily incorporating personal, interpersonal and institutional variables. A paradigm shift is urgently needed to incorporate
these critical factors in antimicrobial optimization strategies. Strategies that might utilise social influences in antimicrobial optimisation will be discussed.