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

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

doi:10.3390/antibiotics10010047

Sajal K Saha, Danielle Mazza + Show 2 more

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https://doi.org/10.3390/antibiotics10010047

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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.

Highlights

Though the proportionate distribution of responses of both General practitioners (GPs) and community pharmacists (CPs) across six Australian states and two territories and by gender was similar to the reports published by the Australian Government Department of Health
Our findings suggest that the current GP–CP collaboration in antimicrobial stewardship (AMS) is a piecemeal process, but increased trust towards each other’s professional competency and appreciation of each other’s AMS roles might foster good collaboration
This study was a part of an overarching research project to develop a GP–pharmacist collaborative AMS (GPPAS) model in improving AMS implementation in Australian primary care

Summary

Introduction

Primary care significantly contributes to the rising antimicrobial resistance (AMR)because both prescribing and inappropriate prescribing of antimicrobials occur most in this setting. [1] in response, the actions and framework to implement antimicrobial stewardship (AMS) programs with an interprofessional engagement are limited in this setting. [2] AMS programs are strategic interventions that aim to optimise antimicrobial use, improve patient safety, and reduce AMR [3].There are international guidelines and recommendations, practical tool kits, and models of care to facilitate AMS programs in primary care [4,5,6,7] but, attempts to implement these in clinical practice have significant challenges [8]. A key challenge is the lack of team-based antimicrobial care provision or services in primary care, where prescribing and dispensing occur independently and without pharmacists acting as provider of triage services. General practitioners (GPs) and community pharmacists (CPs) are the most important stewards of antimicrobial use [10,11] in primary care, for which there should be a greater scope for collaboration between these two professions [12,13] to implement effective AMS programs. Practical GP–CP collaborative models for AMS in the Australian health care setting remain poorly delineated; context-specific challenges and effective attempts are neither well known nor clear. Doctor-pharmacist collaborative models exist to promote AMS in a secondary or tertiary care settings [14,15], it may be unrealistic to use these models in primary care due to the divergence in routine practices, distant working environment, organisational set-up, and different patterns of antimicrobial use between health care settings

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