Abstract
There is little guidance about developing systems for antimicrobial stewardship (AMS) for general practice. A literature review identified six key components: governance, monitoring of antibiotic prescribing and resistance with feedback to prescribers, consultation support, education of the public and general practitioners, pharmacist and nurse involvement, and research, which were incorporated into a potential framework for the general practice context. Objectives: to determine the feasibility and validity of the proposed AMS framework. A secondary objective was to identify likely bodies responsible for implementation in Australia. We undertook interviews with 12 key stakeholders from government, research, and professional groups. Data were analysed with a thematic approach. The framework was considered valid and feasible. No clear organisation was identified to lead AMS implementation in general practice. The current volume-based antibiotic prescription monitoring system was considered insufficient. AMS education for the public, further development of GP education, and improved consultation support were strongly recommended. The role of community-based pharmacists and nurses is largely unexplored, but their involvement was recommended. A clear leader to drive AMS in general practice is essential for an action framework to gain traction. Monitoring and feedback of antibiotic prescribing require urgent development to include monitoring of prescribing appropriateness and patient outcomes.
Highlights
Antimicrobial resistance is a global problem with a major impact on health care and associated costs [1]
Antibiotics are prescribed at rates 4–9 times that recommended by the Australian national antibiotic prescribing guidelines Therapeutic Guidelines—Antibiotic [6]
Of the 24 invited stakeholders, 13 accepted. Another was on extended leave, and eight did not respond to two emails. One of those who declined—despite being invited to participate as an expert, not as a representative—replied, “[name of organisation] is not in the best place to help with your query regarding antimicrobial stewardship (AMS) in general practice and we recommend you contact
Summary
Antimicrobial resistance is a global problem with a major impact on health care and associated costs [1]. There is a high rate of prescribing of moderate- (66% of use) and broad-spectrum antibiotics (25%) [5], and inappropriate use is still common for conditions such as upper respiratory tract infections [4]. For these conditions, antibiotics are prescribed at rates 4–9 times that recommended by the Australian national antibiotic prescribing guidelines Therapeutic Guidelines—Antibiotic [6].
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