Antimicrobial stewardship in remote primary healthcare across northern Australia

Abstract

Background The high burden of infectious disease and associated antimicrobial use likely contribute to the emergence of antimicrobial resistance in remote Australian Aboriginal communities. We aimed to develop and apply context-specific tools to audit antimicrobial use in the remote primary healthcare setting. Methods We adapted the General Practice version of the National Antimicrobial Prescribing Survey (GP NAPS) tool to audit antimicrobial use over 2–3 weeks in 15 remote primary healthcare clinics across the Kimberley region of Western Australia (03/2018–06/2018), Top End of the Northern Territory (08/2017–09/2017) and far north Queensland (05/2018–06/2018). At each clinic we reviewed consecutive clinic presentations until 30 presentations where antimicrobials had been used were included in the audit. Data recorded included the antimicrobials used, indications and treating health professional. We assessed the appropriateness of antimicrobial use and functionality of the tool. Results We audited the use of 668 antimicrobials. Skin and soft tissue infections were the dominant treatment indications (WA: 35%; NT: 29%; QLD: 40%). Compared with other settings in Australia, narrow spectrum antimicrobials like benzathine benzylpenicillin were commonly given and the appropriateness of use was high (WA: 91%; NT: 82%; QLD: 65%). While the audit was informative, non-integration with practice software made the process manually intensive. Conclusions Patterns of antimicrobial use in remote primary care are different from other settings in Australia. The adapted GP NAPS tool functioned well in this pilot study and has the potential for integration into clinical care. Regular stewardship audits would be facilitated by improved data extraction systems.

Antimicrobial stewardship in rural and remote primary health care: a narrative review

“…While this study portrayed a positive outlook in Australia, the results cannot be generalised as the focus was on early-career general practitioners and urinary tract infections only, and rural practices constituted only 16% of the study locations [ 40 ]. An audit of antimicrobial use in 15 remote PHC clinics across three states in northern Australia found that appropriateness was high compared to general practices in urban settings [ 45 ]. Approximately 91%, 82% and 65% of antimicrobial use in Western Australia, Northern Territory and Queensland adhered to clinical guidelines, endorsed by experts, or constituted agents with the narrowest targets.…”

“…Approximately 91%, 82% and 65% of antimicrobial use in Western Australia, Northern Territory and Queensland adhered to clinical guidelines, endorsed by experts, or constituted agents with the narrowest targets. This appreciably high level of appropriateness was demonstrated by 86% of nurses and 73% of doctors in this region [ 45 ]. The high rates of appropriateness in this study may be a result of government endorsed clinical guidelines that the nurses are legally bound to comply with in order to prescribe.…”

“…7% ( n = 4) of patients permitted the community pharmacist to contact the prescriber to discuss first-line therapeutic alternatives. 2 of 3 clinicians contacted by pharmacists were receptive to altering the broad-spectrum antimicrobial to first-line antimicrobial therapy Surveillance Rural and remote [ 45 ] Cuningham 2020 Retrospective data analysis Prevalence Study (9/9) Northern Australia 15 remote primary health care clinics The General Practice version of the National Antimicrobial Prescribing Survey (GP NAPS) tool modified for remote primary health care clinics Antimicrobials used, indications and the treating health professional to yield similarities and differences in prescribing patterns, appropriateness of antimicrobial use and functionality of the GP NAPS tool The adapted GP NAPS tool demonstrated potential as an audit tool of antimicrobial use for the remote primary health care setting in Australia. Compared with other Australian settings, narrow spectrum antimicrobials were more commonly prescribed with high appropriateness of use (WA: 91%; NT: 82%; QLD: 65%).…”

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

“…If these resources were available, CPs could be more engaged in performing antimicrobial audits, reviewing antimicrobial prescriptions, and providing feedback to GPs. In Australia, a tool [38] to audit antimicrobial use in the context of remote primary healthcare has been tested and this tool could be integrated into clinical practice in future.…”

“…To our knowledge, this is the first study internationally that compares and contrasts the views of GPs and CPs about the collaborative implementation of AMS, both quantitatively and qualitatively, through two nationwide surveys. In the hospital settings, there is much evidence for strong physician-pharmacist collaboration for effective implementation of AMS programs [38,39]. In contrast, this study is very important because the hospital collaborative model is not feasible in the primary care setting, and the results will assist the design of such a model in primary care.…”