title: A mixed methods study of the barriers and enablers in implementing antimicrobial stewardship programmes in Australian regional and rural hospitals.
abstract: OBJECTIVE
  The Australian Commission on Safety and Quality in Health Care released recommendations for antimicrobial stewardship programmes to be established within all Australian healthcare facilities. However, implementation practices are not well defined. The aim of this study was to gain an understanding of factors affecting implementation of antimicrobial stewardship programmes within Australian regional and rural hospitals.
  
  
  METHODS
  This study was designed whereby a preliminary quantitative process was used to contribute to a principally qualitative study. Site visits to regional and rural hospitals in Queensland, New South Wales, Victoria and South Australia were planned to assess factors impacting on implementation of antimicrobial stewardship. Subsequently researchers identified issues requiring further exploration with specific key informant interviews and focus group discussions. Data were collected between May and October 2012 and entered into Nvivo10, openly coded and analysed according to mixed methods data analysis principles.
  
  
  RESULTS
  Regional and rural hospitals were not conducting many of the recommended activities and seven major themes emerged. The key barriers were perceived to be lack of access to education, resources and specialist support. The enablers were a flatter governance structure, greater sense of pride, desire for success and good internet and tele-health access.
  
  
  CONCLUSIONS
  This study helps us to identify where efforts should be focused to facilitate the establishment of antimicrobial stewardship programmes in regional and rural hospitals, by describing the gaps and limitations of current programmes and the major issues currently being faced, providing recommendations to better guide activities that support regional and rural hospitals.
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia NH&MRC National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia rod.james@mh.org.au.
authors.forename: Rodney
authors.initials: R
authors.lastname: James
authors.affiliation: NH&MRC National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Luu
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland 4006, Australia.
authors.forename: Minyon
authors.initials: M
authors.lastname: Avent
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia NH&MRC National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Marshall
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia NH&MRC National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.
authors.forename: Karin
authors.initials: K
authors.lastname: Thursky
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia NH&MRC National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Buising
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001315:Australia; D004363:Drug Utilization / Q000592:standards*; D006780:Hospitals, Rural; D006801:Humans; D007407:Interviews as Topic; D016134:Organizational Policy
chemical_list: D000890:Anti-Infective Agents