Academic journal article Australian Health Review

Implementing Antimicrobial Stewardship in the Australian Private Hospital System: A Qualitative Study

Academic journal article Australian Health Review

Implementing Antimicrobial Stewardship in the Australian Private Hospital System: A Qualitative Study

Article excerpt


Bacterial resistance to antibiotics has been identified as one of the five major threats to mankind by the World Health Organization.1 Inappropriate and excessive use of antibiotics worldwide has accelerated the generation of antibiotic resistance,2 and antibiotic use, particularly in healthcare facilities, is believed to have contributed significantly to this problem.3

'Antimicrobial stewardship' (AMS) is a term used to describe activities that serve to optimise antimicrobial therapy, with the aim of ensuring the best patient outcome while minimising unintended consequences of antimicrobial use, such as adverse drug events and the emergence of antimicrobial resistance among local pathogens.4 Typically, AMS has been introduced as a multifaceted hospital-wide program in many individual healthcare facilities, with studies showing these programs improving care of patients, being cost-efficient and assisting in curtailing antimicrobial resistance.5-8 Given that AMS programs use several different strategies to successfully optimise antimicrobial prescribing in hospitals, these programs rely on extensive multidisciplinary collaboration and coordination, with governance structure provided by hospital executives.9

The introduction of new national healthcare standards in 2013 has made AMS programs a mandatory accreditation requirement for all hospitals in Australia.10 Thus far, AMS programs have predominantly been introduced in larger tertiary public hospitals,11 with limited uptake of AMS initiatives by private hospitals.12 The reasons for this remain largely unknown and could be due to differences in the way health services are delivered between the two hospital systems.

In Australia, private hospitals provide approximately 40% of in-patient care and are operated by organisations for both profit and not for profit.13 The primary source of revenue for private hospitals comes from private health insurance funders as well as direct out-of-pocket payments from patients (termed 'private patients'). These private patients generally choose their own consultant specialist (a doctor who has completed speciality training), who, in turn, chooses a private hospital in which to admit the patient for the required health service. Both consultant specialist and private hospital then bill the patient and/or the patient's health insurance fund for services provided.

Conversely, public hospitals rely directly on government funding.14 Day-to-day care in public hospitals is generally provided by teams consisting of junior medical staff, some of whom are training to be specialists. Consultant specialists are employed by public hospitals to provide a senior role and their primary responsibility is tosuperviseandconsult withjuniormedicalstaff.

The qualitative research presented in this article formed part of a larger project examining antimicrobial use, attitudes towards AMS and current resources in the Australian private hospital sector.12,15,16 The aim of this study was to explore organisational factors and barriers that currently limit implementation of AMS in a large Australian private hospital and to determine potential solutions for AMS implementation.


The present qualitative study involved participants employed, contracted or affiliated with one of the largest private hospital operators in Australia. Over 500 consultant specialists currently consult at the main hospital, including 13 infectious diseases (ID) physicians. There are 800 employed nurses, three employed infection control practitioners (ICPs) and contracted external pathology and pharmacy service providers. The hospital has a 15-bed intensive care unit, a day oncology facility and busy orthopaedic, cardiology and neurosurgical services. No paediatric, obstetric or solid organ transplant services are provided. There was no formal AMS program at the hospital during the time of the study.

A focus group discussion (FGD)17 study was deemed the most appropriate qualitative research method to explore factors requiring consideration when implementing AMS in the private hospital system. …

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