Remote realities: In-depth conversations on antimicrobial stewardship in remote Indigenous communities using a One Health approach.

A One Health approach encourages transdisciplinarity and equity when working to optimise the health of people, animals and the environment. It is helpful to use a One Health approach to explore issues such as antimicrobial resistance (AMR), where a traditionally medicalised focus may otherwise prevent investigation or understanding of lesser known but still relevant influences. In-depth interviews with fourteen participants (nurses, doctors, Aboriginal health workers, veterinarians and antimicrobial stewardship (AMS) pharmacists) were conducted to explore under-investigated topics of AMR and AMS in remote communities as they relate to medical and veterinary practice. We aimed to explore the relationships between factors influencing antimicrobial use and health systems, such as the social determinants of health. Staff shortages and high workload were identified as factors that influenced AMS and the capacity of prescribers to make more appropriate antimicrobial choices. Generally low antimicrobial use in remote community veterinary practice was identified, however veterinary surgical prophylaxis is an area where the quality of prescribing could be improved. Other enablers for AMS include the positive influence of local Aboriginal health practitioners and their equivalents in animal health, openness by participants to improve their practices, and evidence amongst participants of understanding or acknowledgement of upstream drivers of AMR and interest in working collaboratively across disciplines.