BMC Global and Public Health (Aug 2024)

“It’s easier to take a pill than fix a problem:” qualitative analysis of barriers and facilitators to antimicrobial stewardship program implementation in carceral settings

  • Rebecca A. Tenner,
  • Emily D. Grussing,
  • David Manning,
  • Yvane Ngassa,
  • Jacob J. van den Berg,
  • Gabriela Andujar Vazquez,
  • Shira Doron,
  • Maureen Campion,
  • Alysse G. Wurcel

DOI
https://doi.org/10.1186/s44263-024-00090-1
Journal volume & issue
Vol. 2, no. 1
pp. 1 – 11

Abstract

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Abstract Background Widespread antibiotic prescribing contributes to globally emerging antimicrobial resistance (AMR). Despite stewardship recommendations by the Infectious Diseases Society of America, there is a lack of literature identifying barriers and facilitators to antimicrobial stewardship programs (ASPs) in United States (U.S.) carceral settings. Methods Guided by the Theoretic Domains Framework, we performed in-depth interviews with 68 key stakeholders in Massachusetts carceral settings to contextualize barriers and facilitators to ASP implementation. We recruited 32 people incarcerated in Massachusetts jails and 36 carceral clinicians, correctional officers/administrators in Massachusetts and other U.S. states, and Massachusetts community clinicians for interviews. Results From the completed semi-structured in-depth interviews, we identified seven salient themes—four barriers and three facilitators—both specific to and across stakeholder groups. Barriers included the following: (1) jail being viewed as a “dirty place” that increases the risk of infections; (2) variable awareness and knowledge of AMR and ASPs; (3) clinicians’ opposition to change and oversight of their antibiotic prescribing; (4) competing priorities taking precedence over ASP implementation. Facilitators included (5) interest in changing the narrative about carceral healthcare through ASP implementation; (6) opportunities for education about ASP and AMR; and (7) the development of systems, policies, and regulations to improve antibiotic prescribing. Conclusions To our knowledge, this is the first qualitative study to leverage broad criminal-legal stakeholder groups to inform the next steps in developing and implementing ASPs in carceral settings in the U.S.

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