A systems thinking approach for antimicrobial stewardship in primary care

Sajal K. Saha, David C.M. Kong, Danielle Mazza, Karin Thursky

Research output: Contribution to journalArticleResearchpeer-review

4 Citations (Scopus)


Introduction: The establishment of antimicrobial stewardship (AMS) in primary care is central to substantially reduce the antimicrobial use and the associated risk of resistance. This perspective piece highlights the importance of systems thinking to set up and facilitate AMS programs in primary care. Areas covered: The challenges that primary care faces to incorporate AMS programmes is multifactorial: an implementation framework, relevant resources, team composition, and system structures remain under-researched, and these issues are often overlooked and/or neglected in most parts of the world. Progress in the field remains slow in developed countries but potentially limited in low- and middle-income countries. Expert opinion: The key AMS strategies to optimize antimicrobial use in primary care are increasingly known; however, health system components that impact effective implementation of AMS programs remain unclear. We highlight the importance of systems thinking to identify and understand the resource arrangements, system structures, dynamic system behaviors, and intra- and interprofessional connections to optimally design and implement AMS programs in primary care. An AMS systems thinking systemigram (i.e. a visual representation of overall architecture of a system) could be a useful tool to foster AMS implementation in primary care.

Original languageEnglish
Pages (from-to)819-827
Number of pages9
JournalExpert Review of Anti-Infective Therapy
Issue number6
Publication statusPublished - 3 Jun 2022


  • Antimicrobial stewardship
  • primary care
  • systems thinking

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