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

Abstract

Setting up an interprofessional team for antimicrobial stewardship (AMS) to improve the quality and safety of antimicrobial use in primary care is essential but challenging. This study aimed to investigate the convergent and divergent attitudes and views of general practitioners (GPs) and community pharmacists (CPs) about AMS implementation and their perceived challenges of collaboration to design a GP–pharmacist collaborative AMS (GPPAS) model. Nationwide surveys of GPs and CPs across Australia were conducted January-October 2019. Chi square statistics and a theoretical framework were used for comparative analyses of quantitative and qualitative data, respectively. In total, 999 participants responded to the surveys with 15.4% (n = 386) response rates for GPs and 30.7% (n = 613) for CPs. GPs and CPs were aware about AMS however their interprofessional perceptions varied to the benefits of AMS programs. CPs indicated that they would need AMS training; significantly higher than GPs (GP vs. CP; 46.4% vs. 76.5%; p < 0.0001). GPs’ use of the Therapeutic Guideline Antibiotic was much higher than CPs (83.2% vs. 45.5%; p < 0.0001). No interprofessional difference was found in the very-limited use of patient information leaflets (p < 0.1162) and point-of-care tests (p < 0.7848). While CPs were more willing (p < 0.0001) to collaborate with GPs, both groups were convergent in views that policies that support GP–CP collaboration are needed to implement GPPAS strategies. GP–pharmacist collaborative group meetings (54.9% vs. 82.5%) and antimicrobial audit (46.1% vs. 86.5%) models were inter-professionally supported to optimise antimicrobial therapy, but an attitudinal divergence was significant (p < 0.001). The challenges towards GP–CP collaboration in AMS were identified by both at personal, logistical and organisational environment level. There are opportunities for GP–CP collaboration to improve AMS in Australian primary care. However, strengthening GP–pharmacy collaborative system structure and practice agreements is a priority to improve interprofessional trust, competencies, and communications for AMS and to establish a GPPAS model in future.

Community pharmacists’ views on their current role and future opportunities for antibiotic stewardship: a French qualitative study

“…Ways to facilitate discussion and teamwork and to promote trust between professionals may include regular GP–CP group meetings, practice agreements and greater interactions during initial and continuing training. 46 , 47 …”

A Novel GPPAS Model: Guiding the Implementation of Antimicrobial Stewardship in Primary Care Utilising Collaboration between General Practitioners and Pharmacists

“…The mode of implementation involves GP-pharmacist regular group meetings and GP-pharmacist co-led workshop training. Study GPs and CPs in Australia have a motivation to be involved in the co-construction of AMS knowledge by collaborative learning processes [24]. A GP-CP collaborative group meetings model was inter-professionally supported (GPs vs. CPs; 54.9% vs. 82.5%) to optimise antimicrobial therapy though there was an attitudinal divergence [24].…”

“…Study GPs and CPs in Australia have a motivation to be involved in the co-construction of AMS knowledge by collaborative learning processes [24]. A GP-CP collaborative group meetings model was inter-professionally supported (GPs vs. CPs; 54.9% vs. 82.5%) to optimise antimicrobial therapy though there was an attitudinal divergence [24]. This result indicates that GPs should be open enough to inter-professionally share and accept interventions when justified to improve the quality of antimicrobial prescription(s) and to learn as a team.…”

Antimicrobial stewardship in Australia: the role of qualitative research in programme development

“… 88–92 Though there were differences in GPs’ and community pharmacists’ receptiveness to participation in collaborative GP–community pharmacist group meetings (54.9% versus 82.5%) and antimicrobial audits (46.1% versus 86.5%), opportunities to improve interprofessional trust, technological capabilities and organizational and environmental factors were identified. 90 …”