{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T06:55:41Z","timestamp":1765781741775,"version":"3.48.0"},"reference-count":29,"publisher":"CSIRO Publishing","issue":"3","license":[{"start":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T00:00:00Z","timestamp":1755388800000},"content-version":"vor","delay-in-days":2054,"URL":"https:\/\/doi.org\/10.1071\/journalslicense"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of this study was to explore the features of sustainable antimicrobial stewardship (AMS) programs in Australian rural hospitals and develop recommendations on incorporating these features into rural hospitals\u2019 AMS programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Lead AMS clinicians with knowledge of at least one AMS program sustained for &amp;gt;2 years in a health service in rural Australia were recruited to the study. A series of interviews was conducted and the transcripts analysed thematically using a framework method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifteen participants from various professional disciplines were interviewed. Key features that positively affected the sustainability of AMS programs in rural hospitals included a hospital executive who provided strong governance and accountability, dedicated resources, passionate local champions, area-wide arrangements and adaptability to engage in new partnerships. Challenges to building AMS programs with these features were identified, particularly in engaging hospital executive to allocate AMS resources, managing the burn out of passionate champions and formalising network arrangements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Strategies to increase the sustainability of AMS programs in rural hospitals include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop formal network arrangements and a framework for integrated AMS programs across primary, aged and acute care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>What is known about the topic?<\/jats:title>\n                    <jats:p>AMS programs facilitate the responsible use of antimicrobials. Implementation challenges have been identified for rural hospitals, but the sustainability of AMS programs has not been explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>What does this paper add?<\/jats:title>\n                    <jats:p>Factors that positively affected the sustainability of AMS programs in rural hospitals were a hospital executive that provided strong governance and accountability, dedicated resources, network or area-wide arrangements and adaptability. Challenges to building AMS programs with these features were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>What are the implications for practitioners?<\/jats:title>\n                    <jats:p>Recommended actions to boost the sustainability of AMS programs in rural hospitals are required. These include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop network arrangements and support to create integrated AMS programs across acute, aged and primary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/ah19097","type":"journal-article","created":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T21:40:55Z","timestamp":1577914855000},"page":"415-420","source":"Crossref","is-referenced-by-count":8,"title":["Sustainability of antimicrobial stewardship programs in Australian rural hospitals: a qualitative study*"],"prefix":"10.1071","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8988-2203","authenticated-orcid":true,"given":"Jaclyn L.","family":"Bishop","sequence":"first","affiliation":[{"name":"ANational Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Vic. 3000, Australia. Email: Thomas.Schulz@mh.org.au"},{"name":"BDepartment of Medicine \u2013 Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Royal Parade, Melbourne, Vic. 3050, Australia."},{"name":"CPharmacy Department, Ballarat Health Services, Drummond Street, Ballarat, Vic. 3350, Australia."},{"name":"FCorresponding author. Email: jaclynb@student.unimelb.edu.au"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas R.","family":"Schulz","sequence":"additional","affiliation":[{"name":"ANational Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Vic. 3000, Australia. Email: Thomas.Schulz@mh.org.au"},{"name":"BDepartment of Medicine \u2013 Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Royal Parade, Melbourne, Vic. 3050, Australia."},{"name":"DVictorian Infectious Diseases Service, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Vic. 3050, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C. M.","family":"Kong","sequence":"additional","affiliation":[{"name":"ANational Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Vic. 3000, Australia. Email: Thomas.Schulz@mh.org.au"},{"name":"BDepartment of Medicine \u2013 Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Royal Parade, Melbourne, Vic. 3050, Australia."},{"name":"CPharmacy Department, Ballarat Health Services, Drummond Street, Ballarat, Vic. 3350, Australia."},{"name":"ECentre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Vic. 3052, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsty L.","family":"Buising","sequence":"additional","affiliation":[{"name":"ANational Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Vic. 3000, Australia. Email: Thomas.Schulz@mh.org.au"},{"name":"BDepartment of Medicine \u2013 Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Royal Parade, Melbourne, Vic. 3050, Australia."},{"name":"DVictorian Infectious Diseases Service, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Vic. 3050, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"67","published-online":{"date-parts":[[2020,1,2]]},"reference":[{"key":"2025121501534105400_R1"},{"key":"2025121501534105400_R2"},{"key":"2025121501534105400_R3"},{"key":"2025121501534105400_R4","doi-asserted-by":"publisher","first-page":"333","DOI":"10.4212\/cjhp.v69i4.1577","article-title":"Development of an antimicrobial stewardship program in a rural and remote health authority.","volume":"69","author":"Pammett","year":"2016","journal-title":"Can J Hosp Pharm"},{"key":"2025121501534105400_R5","first-page":"1","article-title":"New antimicrobial stewardship standard.","volume":"36","author":"The Joint Commission","year":"2016","journal-title":"Jt Comm Perspect"},{"key":"2025121501534105400_R6","doi-asserted-by":"publisher","first-page":"4442","DOI":"10.22605\/RRH4442","article-title":"Meeting the challenge for effective antimicrobial stewardship programs in regional, rural and remote hospitals \u2013 what can we learn from the published literature?","volume":"18","author":"Bishop","year":"2018","journal-title":"Rural Remote Health"},{"key":"2025121501534105400_R7","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1016\/j.jhin.2018.09.014","article-title":"Qualitative study of the factors impacting antimicrobial stewardship programme delivery in regional and remote hospitals.","volume":"101","author":"Bishop","year":"2019","journal-title":"J Hosp Infect"},{"key":"2025121501534105400_R8","doi-asserted-by":"publisher","first-page":"2665","DOI":"10.1093\/jac\/dkv159","article-title":"A mixed methods study of the barriers and enablers in implementing antimicrobial stewardship programmes in Australian regional and rural hospitals.","volume":"70","author":"James","year":"2015","journal-title":"J Antimicrob Chemother"},{"key":"2025121501534105400_R9","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1093\/cid\/cix409","article-title":"Implementation of antimicrobial stewardship programs in small community hospitals: recognizing the barriers and meeting the challenge.","volume":"65","author":"Sexton","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2025121501534105400_R10","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1093\/cid\/cix407","article-title":"Antibiotic stewardship in small hospitals: barriers and potential solutions.","volume":"65","author":"Stenehjem","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2025121501534105400_R11"},{"key":"2025121501534105400_R12"},{"key":"2025121501534105400_R13"},{"key":"2025121501534105400_R14","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough? 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