The application of the Hub and Spoke Model in Antimicrobial Stewardship Programmes - A Scoping Review

Background: The hub-and-spoke model (HSM), offers a framework for efficient healthcare service delivery. This scoping review seeks to establish the implementation and effectiveness of the HSM in Antimicrobial Stewardship (AMS) programs. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guideline was followed. A systematic search was conducted in four electronic databases (PubMed, Medline, Cochrane library and Google scholar) from inception until January 2024. Studies where the HSM was used for delivering any AMS activity, intervention or action, were included. No study specific filters were applied and all populations, study designs and health settings were included. Data screening and selection was achieved using Rayyan. Three authors independently screened studies, with conflicts resolved by a fourth author. Data were narratively synthesized. Standard appraisal tools were impractical; however, critically evaluation of data collection and outcome reporting was ensured. Results: Out of 1,438 articles, three were included in the scoping review. The primary interventions utilising the HSM in AMS involved reducing antibiotic misuse, training healthcare professionals, case-based learning, establishing AMS programs, developing antibiograms, and formulating policies or guidelines pertinent to AMS. The studies demonstrated significant clinical improvements in AMS. Clinical outcomes from the studies include a significant reduction in antimicrobial usage and improved antibiotic management, with a notable decrease in days on antimicrobial therapy and increased antibiotic de-escalation. Key facilitators for AMS program success: tailored education, collaborative learning, strong leadership, strategic practices, and data-driven decisions. Key barriers: leadership challenges, change resistance, knowledge gaps, inadequate data systems, resource limitations, and technological constraints. Conclusion: The review identified a literature gap in HSM use for AMS programs. Further studies are needed to assess HSM's effectiveness, feasibility, and cost-effectiveness in AMS contexts.