A Nationwide Survey of Australian General Practitioners on Antimicrobial Stewardship: Awareness, Uptake, Collaboration with Pharmacists and Improvement Strategies

Abstract

Implementing antimicrobial stewardship (AMS) programs is central to optimise antimicrobial use in primary care. This study aims to assess general practitioners’ (GPs’) awareness of AMS, uptake of AMS strategies, attitudes towards GP–pharmacist collaboration in AMS and future AMS improvement strategies. A paper-based survey of nationally representative GPs across Australia was conducted in 2019. Of 386 respondent GPs, 68.9% were familiar with AMS. Respondents most frequently used the Therapeutic Guidelines (TG) (83.2%, 321/385) and delayed antimicrobial prescribing (72.2%, 278/385) strategies, whereas few utilised point-of-care tests (18.4%, 71/382), patient information leaflets (20.2%, 78/384), peer prescribing reports (15.5%, 60/384) and audit and feedback (9.8%, 38/384). GPs were receptive to pharmacists’ recommendations on the choice (50.5%, 192/381) and dose (63%, 241/382) of antimicrobials, and more than 60% (235/381) supported a policy fostering increased GP–pharmacist collaboration. Most GPs agreed to have AMS training (72%, 278/386), integration of electronic TG (eTG) with prescribing software (88.3%, 341/386) and policies limiting the prescribing of selected antimicrobials (74.4%, 287/386) in the future. Conclusively, GPs are aware of the importance of judicious antimicrobial prescribing but inadequately uptake evidence-based AMS strategies. The majority of GPs support GP–pharmacist collaborative AMS approaches to optimise antimicrobial use. Developing a feasible GP–pharmacist collaborative AMS implementation model and facilitating stewardship resources and training could foster AMS activities in primary care.

Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study

“…We framed this study comparing two nationwide surveys of GPs and CPs on AMS to explore interprofessional perspectives of implementing AMS in collaboration between GPs and CPs. We undertook two nationwide surveys of GPs and CPs across Australia between January and October in 2019.The detailed methodologies of the survey design and survey tools used are found in the published literature [47,48]. The two-stage stratified random sampling method was employed to select nationally representative samples of 2500 GPs and 2160 CPs using the Australasian Medical Publishing Company (Ampco) database [49] and a pharmacy database.…”

“…Two survey tools were developed involving the representatives from the National Centre for Antimicrobial Stewardship (NCAS) and the Department of General Practice of Monash University. A systematic review of GP-pharmacist collaborative AMS strategies, a scoping review of 10 AMS surveys of CPs, and other AMS surveys of GPs were the sources of the survey items [16,20,47].…”

Development of a Tailored, Complex Intervention for Clinical Reflection and Communication about Suspected Urinary Tract Infections in Nursing Home Residents

“…Antibiotic stewardship programs generate mixed results, using education, decision algorithms, and communication tools to reduce inappropriate antibiotic prescribing for UTIs in nursing homes [ 22 ]. Studies have shown that uptake of antibiotic stewardship can be inadequate, perhaps because attention to implementation barriers is neglected [ 23 , 24 ]. “Tailored” interventions are planned interventions that follow an investigation of factors that explain current practices and seek to uncover reasons underlying the resistance to new practices [ 25 ].…”

Standard of practice in infectious diseases for pharmacy services

“…Proposed activities for AMS have been included in the RACGP’s Standards for General Practice, however, this is only a voluntary accreditation process for GP practices 52 . Pharmacists, in general, are well‐placed to be effective stewards of antimicrobials and are able to play a significant role in collaboration with other healthcare professionals, to optimise the quality use of antimicrobials and help achieve the accreditation standards in primary care 53,54 . Potential roles for pharmacists can occur at the following levels: patient, clinical and system, with suggested activities listed in Table 2 55 …”