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

Sajal K Saha,David C M Kong,Danielle Mazza,Karin Thursky

doi:10.3390/antibiotics9060310

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.

Highlights

Optimising the use of antimicrobials in primary care is gaining much attention, with the awareness that most overuse of antimicrobials occurs in this setting [1]
Programs in all health care settings [6], but the antimicrobial stewardship (AMS) clinical care standard is still not established in general practice [7]
AMS resources targeting Australian health professionals have been on the rise, such as indicators to support AMS, user guides and patient decision aids [8]

Summary

Introduction

Optimising the use of antimicrobials in primary care is gaining much attention, with the awareness that most overuse of antimicrobials occurs in this setting [1]. Australia has been listed in the top 25% of countries in prescribing antibiotics in primary care [2]. Researching antimicrobial stewardship (AMS) programs in Australian general practices is a priority. AMS involves co-ordinated interventions or strategies to optimise antimicrobial use, ensure accessibility to effective antimicrobial therapy, improve patient outcomes and reduce antimicrobial resistance (AMR) [5]. In Australia, the National AMR Strategy 2015–2019 aimed to establish AMS programs in all health care settings [6], but the AMS clinical care standard is still not established in general practice [7]. 4. Proportion of of GPsGPs agreeing with with futurefuture strategies to improve AMS in general. Proportion agreeing strategies to improve AMS practice. Of theCollege surveyedofparticipants, 57.25% of GPs (221/386) should reporteddefine barrierstheir and roles

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