Antimicrobial Stewardship in Rural and Remote Primary Healthcare Centers: A Systematic Review
Keywords:
Antimicrobial Stewardship, Rural, Clinical Trials, Antibiotic Prescription, SatisfactionAbstract
Introduction:
Studies have shown that the rate of antibiotic prescription in these areas is significantly higher than in urban settings, with one study reporting that rural general practitioners (GPs) prescribe antibiotics. This systematic review aimed to evaluate the current state of antimicrobial stewardship in rural and remote primary health care settings.
Methods:
This systematic review, adhering to PRISMA guidelines, focused on evaluating the impact of antimicrobial stewardship programs in rural and remote primary health care through interventional studies and clinical trials. A comprehensive literature search across multiple databases and registries, including PubMed and ClinicalTrials.gov, was conducted, using tailored search terms to identify relevant studies conducted between January 2000 and August 2023. The review process involved stringent screening, data extraction, and quality assessment, culminating in a detailed synthesis of the interventions' effectiveness on antimicrobial use, resistance patterns, and improvements in patient care in these specific healthcare settings.
Results:
The systematic review analyzed seven interventional studies and clinical trials on antimicrobial stewardship in rural and remote primary health care, revealing a diversity in methodology, location, focus, and sample sizes ranging from 58 to over 500 participants. These studies incorporated various interventions, such as educational programs, patient awareness campaigns, and digital decision support systems, leading to a range of outcomes. Key findings included a significant reduction in antibiotic prescription turnover, with risk differences as high as -20%, and an increase in healthcare provider satisfaction, reaching up to 30%, underscoring the effectiveness of tailored stewardship approaches in these unique healthcare settings.
Conclusions:
This systematic review on antimicrobial stewardship in rural and remote primary health care settings analyzed seven interventional studies, revealing significant improvements in antibiotic prescribing practices and healthcare provider satisfaction. The interventions, including educational programs, digital tools, and patient campaigns, led to a substantial reduction in antibiotic prescription turnover
