General Practitioner and Practice Manager Perspectives on an Integrated Antimicrobial Stewardship Program in Primary Care: A Qualitative Exploration

Background/Objectives: Antimicrobials are regularly prescribed in general practice, yet the infrastructure to support routine review of prescribing in this setting remains limited. Integrated antimicrobial stewardship (AMS) interventions combining automated auditing of routine prescribing data with an educational component are a promising approach to addressing this gap. This qualitative study aimed to explore general practitioner (GP) and practice manager (PM) perspectives on the acceptability, feasibility, and perceived effectiveness of such an intervention implemented across 31 general practices and 97 GPs in Victoria, Australia. It also explored implementation considerations relevant to future scaling of the intervention. This is one of the first studies of GP and PM perspectives on this type of integrated program. Methods: Semi-structured interviews were conducted with 17 GPs and 5 PMs and analyzed using both inductive and deductive thematic analysis. The Theoretical Domains Framework (TDF) informed interview guide development and deductive coding; themes were generated inductively and final themes mapped to the Capability, Opportunity, Motivation–Behavior (COM-B) model for presentation. Results: Four themes were identified: (1) trust, validity, and value of audit and feedback; (2) clinical judgement and patient factors in prescribing complexity; (3) social, organizational, and professional contexts of learning and behavior change; and (4) effort, usability, and workflow in engagement with the intervention. Conclusions: Participants valued AMS activities that supported reflective practice without undermining professional autonomy. Trust in the systems managing prescribing data was a precondition for engagement with the data itself. Engagement also depended on fit with existing workflows, individualized reporting, and contextualized feedback. The social conditions under which learning occurred, such as peer interaction, moderated discussion, and collaborative reflection, mattered as much as the technical components of a program.