Do you see the problem? Visualising a generalised 'complex local system' of antibiotic prescribing across the United Kingdom using qualitative interview data

Rebecca E Glover; Nicholas B Mays; Alec Fraser

doi:10.1080/09581596.2023.2210743

Do you see the problem? Visualising a generalised 'complex local system' of antibiotic prescribing across the United Kingdom using qualitative interview data

Crit Public Health. 2023 Jun 13;33(4):459-471. doi: 10.1080/09581596.2023.2210743. eCollection 2023.

Authors

Rebecca E Glover¹, Nicholas B Mays¹, Alec Fraser²

Affiliations

¹ Policy Innovation Research Unit, London School of Hygiene and Tropical Medicine, London, UK.
² Public Services Management and Organisation, Kings College London, London, UK.

Abstract

Antimicrobial resistance (AMR) is often referred to as a complex problem embedded in a complex system. Despite this insight, interventions in AMR, and in particular in antibiotic prescribing, tend to be narrowly focused on the behaviour of individual prescribers using the tools of performance monitoring and management rather than attempting to bring about more systemic change. In this paper, we aim to elucidate the nature of the local antibiotic prescribing 'system' based on 71 semi-structured interviews undertaken in six local areas across the United Kingdom (UK). We applied complex systems theory and systems mapping methods to our qualitative data to deepen our understanding of the interactions among antibiotic prescribing interventions and the wider health system. We found that a complex and interacting set of proximal and distal factors can have unpredictable effects in different local systems in the UK. Ultimately, enacting performance management-based interventions in the absence of in-depth contextual understandings about other pressures prescribers face is a recipe for temporary solutions, waning intervention effectiveness, and unintended consequences. We hope our insights will enable policy makers and academics to devise and evaluate interventions in future in a manner that better reflects and responds to the dynamics of complex local prescribing systems.

Keywords: Antimicrobial resistance; complex system; prescribing.

Grants and funding

REG and NM were funded by the NIHR Policy Research Programme through its core support to the Policy Innovation and Evaluation Research Unit [Project No: PR-PRU-1217-20602]. The views expressed are those of the author(s) and are not necessarily those of the NIHR or the Department of Health and Social Care.