Antimicrobial resistance (AMR) is an emerging public health problem worldwide and a significant threat to mankind. Along with different initiatives to combat AMR, antimicrobial stewardship programmes (AMSP) are being implemented globally, especially in hospital settings. Various study reveals that the AMSP in primary health care (PHC) is not well implemented although PHC has a significant role in delivering health care to the communities, particularly in rural and remote areas.
The narrative review conducted by Yau et al 2021, aimed to identify the evidence of the emergence of AMR associated with antimicrobial use and the effectiveness of AMS interventions in the rural and remote PHC setting. Articles were searched in seven online databases: Scopus, Cochrane, Embase, CINAHL, PubMed, Ovid Medline and Ovid Emcare. The relevant articles that are published between 2000 and 2020 included to capture studies with greater relevance to current clinical practice and are suitable for analysis.
The study found that inappropriate and extensive prescribing and use of antimicrobials directly contributed to increasing AMR. The doctor’s knowledge, attitude and behavior play key roles in mediating antimicrobial prescribing with different influencing patient factors. In the primary health care setting of rural and remote areas, AMSP mainly focus on the health care provider and patient education, clinician support systems, utility of antimicrobial resistance surveillance, and policy changes. These interventions can result in appropriate prescription of antimicrobials and decreasing the rate of resistance.
Different physician and patient factors have key role in the control and prevention of AMR, specifically in the resource poor settings of remote and rural areas. The study recommends further research on investigating the effectiveness of interventions over longer durations, capturing the patient perspective and contrasting AMSP in rural and remote settings.
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