The effectiveness of a simple antimicrobial stewardship intervention in general practice in Australia: a pilot study

Abstract

Background: Inappropriate and excessive antimicrobial prescribing can lead to antimicrobial resistance. Antimicrobial Stewardship (AMS) principles are not well established in general practice in Australia despite the relatively high rate of community antimicrobial prescribing. Few interventions have been implemented that have resulted in a significant reduction or improvement in antimicrobial prescribing by General Practitioners (GPs). This study was therefore conducted to assess the impact of a novel GP educational intervention on the appropriateness of antimicrobial prescriptions as well as GP compliance with antimicrobial prescription guidelines. Methods: In 2018, a simple GP educational intervention was rolled out in a large clinic with the aim of improving antimicrobial prescribing. It included face-to-face education sessions with GPs on AMS principles, antimicrobial resistance, current prescribing guidelines and microbiological testing. An antibiotic appropriateness audit on prescribing practice before and after the educational intervention was conducted. Data were summarised using percentages and compared across time points using Chi-squared tests and Poisson regression (results reported as risk ratios (RR) with 95% confidence intervals (CI)).

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

“…The quality improvement strategies have been fitted into a GPPAS model as key components. The Australian pilot study [26] of a GPPAS sub-model conducted in a general practice found that GP educational intervention facilitated by a team of physician and pharmacist was significantly effective in improving appropriateness in antimicrobial selection (73.9% vs 92.8%, RR = 1.26; 95% CI = 1.18-1.34), duration (53.1% vs 87.7%, RR = 1.65; 95% CI = 1.49-1.83) and guideline compliance (42.2% vs 58.5%, RR = 1.39, 95% CI = 1.19-1.61).…”

“…A GPPAS sub-model was well received, cost effective and showed potential for improving appropriateness and guideline compliance of antimicrobial prescribing by GPs in Australia [26]. Whether and how long these improvements sustained after ceasing GPPAS intervention is also worth exploring.…”

“…Such a model has international evidence [53][54][55][56] reported in supplementary table 1. In Australia, GPPAS education model was significantly effective in improving appropriateness in antimicrobial selection (73.9% vs 92.8%, RR = 1.26; 95% CI = 1.18-1.34), duration (53.1% vs 87.7%, RR = 1.65; 95% CI = 1.49-1.83) and guideline compliance (42.2% vs 58.5%, RR = 1.39, 95% CI = 1.19-1.61) [26].…”

Clinical insights into appropriate choice of antimicrobials for acute respiratory tract infections

“…This can be due to clinicians not referring to current guidelines, prescriber error and prescriber discomfort in using recommended high-dose amoxicillin regimens. 14 Further research is required regarding antibiotic prescribing for children with AOM in primary care; however, targeted education, access to Therapeutic Guidelines 15 and clinical decision support tools embedded in practice software prompting prescribers to weigh children and select an appropriate dosing regimen may promote optimal dosing for AOM in children.…”

COVID-19: Questions of Antimicrobial Resistance

“…Perhaps this issue is an added instigating force to the extensive and unnecessary prescribing, utilization, and prescription of antimicrobials 46,[61][62][63] . Multiple studies conducted globally have reported that educational antimicrobial stewardship intervention among health professionals have effectively reduced the imprudent consumption of antimicrobial [64][65][66] . Thereby, it decreases the incidence of hospitalacquired candidemia and the emergence of Multi-Drug Resistant (MDR) Blood Stream Infection (BSI) 64 .…”