Coping with in-locus factors and systemic contradictions affecting antibiotic prescription and dispensing practices in primary care-A qualitative One Health study in Brazil

• Published in: PloS one Vol. 18; no. 1; p. e0280575
• Main Authors: da Silva-Brandao, Roberto Rubem, de Oliveira, Sandi Michele, Correa, Juliana Silva, Zago, Luiz Felipe, Fracolli, Lislaine Aparecida, Padoveze, Maria Clara, Currea, Gloria Cristina Cordoba
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20-01-2023; Public Library of Science (PLoS)
• Subjects: Adaptation, Psychological; Animal health; Animals; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Antimicrobial resistance; Biology and Life Sciences; Brazil; Care and treatment; Context; Dentistry; Dentists; Dispensing; Drug resistance in microorganisms; Evaluation; Global health; Health care; Health risks; Health services; Humans; Medical personnel; Medicine and Health Sciences; Nurses; One Health; Prescription writing; Prescriptions; Primary care; Primary Health Care; Public health; Qualitative research; Research methodology; Risk management; Risk perception; Social factors; Social Sciences; Veterinarians; Brazil
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0280575

Antimicrobial resistance (AMR) is an increasing threat to global health. The risks and sanitary consequences of AMR are disproportionately experienced by those living in Low- and Middle-Income Countries (LMICs). While addressing antibiotic use has largely been documented in hospital settings, the understanding of social drivers affecting antibiotic prescribing and dispensing practices in the context of human and animal health in primary care (PC) in LMICs remains extremely limited. We seek to explore how in-locus and multi-level social factors influence antibiotic prescriptions and dispensing practices in the context of human and animal health in primary care in Brazil. This is a baseline qualitative One Health study; semi-structured interviews and field observations were undertaken in primary care sites located in a socioeconomically vulnerable area in the city of São Paulo, the most populated city of Brazil. Twenty-five human and animal healthcare professionals (HP) were purposely sampled. Interview data were subject to thematic analysis. Three overlapping social drivers were identified across HPs' discourses: individual and behavioral challenges; relational and contextual factors influencing the overprescription of antibiotics (AB); and structural barriers and systemic contradictions in the health system. As a result of the interaction between multilevel in-locus and structural and contextual factors, HPs experience contextual and territorial challenges that directly influence their risk perception, diagnosis, use of laboratorial and image exams, time and decision to undergo treatment, choice of AB and strategies in coping with AB prescriptions. Additionally, in-locus factors influencing antibiotic prescriptions and dispensing practices are intertwined with individual accounts of risk management, systemic contradictions and ambivalences in the national health system. Our findings suggest interventions tackling AB use and AMR in Brazil should consider the social context, the complex health system structure and current integrated programs and services in PC.