Studies to bridge antimicrobial resistance practices and policy : environment, entrepreneurship and epidemiology

Abstract

Objective: Apply policy framework to study clinical and para-clinical factors that enable policy formulation and implementation to tackle antimicrobial resistance. Background: Antimicrobial resistance (AMR) is arguably one of the most challenging public health problems worldwide that can cripple healthcare systems, food security and environmental well-being. The use of antibiotic drugs since the 1940s has led to increased selection pressure, resulting in more severe and broad microbial resistance. Such resistance leads to infections that are difficult to treat or cannot be treated. This problem has been recognized in many sectors including human medicine, food-producing animals, companion animals and the environment. In light of this problem, some nations and professionals have been seeking solutions to improve medical and technical innovations, policy and program formulation and implementation. However, there is still insufficient understanding on what data and conditions facilitate AMR policy formulation and implementation. Our understanding of AMR policymaking, medical professional motivators and the use of clinical data in policy formulation is minimal in some cases and warrants further exploration in other cases. Methods: Classic policy analysis frameworks were examined for their ability to guide AMR policymaking. Three policymaking research foci were developed based on the Multiple Streams Framework: 1) content analysis of AMR policy conditions and structured interviews of protagonists were conducted to study AMR policy environment and entrepreneurship, 2) medical professionals were surveyed and 3) clinical data analysis were conducted to study AMR policy formulation and implementation factors. Findings: By applying Grounded Theory and Consolidated Framework for Implementation Research, we found that pre-existing policies could provide conditions for AMR policy formulation. Capability, Opportunity and Motivation-Behavior framework could be combined with a Knowledge, Attitude and Practice study approach to investigate AMR policy implementation motivators among medical and veterinary medical professionals. A self-controlled case series approach could be a potential statistical application to study patient-based AMR data. In addition, policy protagonists facilitated policy formulation in some nations and international institutions, but not in all circumstances. Moreover, it was observed that further studies involving nations with different ethnographic backgrounds, medical and farming infrastructure and governance approaches, and in general, a larger sample size, could provide data to support and fine-tune antimicrobial use policies and stewardship programs.