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Optimal Implementation of Antimicrobial Stewardship in General Practice: protocol for a feasibility study and
Colin H Cortie1, Mary A Burns1, Margaret Jordan1
1Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2518, Australia.
Background:
Antimicrobial resistance is a worldwide problem caused by the inappropriate use of antibiotics. In Australia, antibiotics are frequently prescribed in general practice (primary care) settings for acute respiratory infections (ARIs) despite these infections most commonly being caused by viruses. The Optimal Implementation of Antimicrobial Stewardship in General Practice (OptimasGP) study aims to provide implementation support for effective antimicrobial stewardship (AMS) interventions for ARIs. The current study will examine if a redesigned workflow, and an AMS Toolbox containing AMS resources, is an acceptable way to access AMS interventions and clinical data collected in general practice settings.
Methods:
A mixed-methods approach will be applied using a single-arm, pragmatic exploratory study. Data will be collected for a period of 3 months. Data collection from general practice settings in New South Wales, Australia, will involve the participation of 4 to 6 practices, 12 general practitioners (GPs), and 6 to 8 practice staff. We also aim to recruit 50-100 patients to complete surveys and 12 patients to participate in focus group discussions. Participating GPs and practice staff will be provided with an online AMS Toolbox to facilitate access to AMS resources. Two hours of online training and a reminder card will also be provided. The AMS Toolbox will contain AMS resources for shared decision-making, clinical decision support (including point-of-care testing), and delayed antibiotic prescribing in patients with ARIs. The primary outcome of the study will be the acceptability of the AMS Toolbox to GPs, practice staff, and patients. Secondary outcomes will include recruitment and completion rates, qualitative findings from the focus group discussions, resource use and antibiotic prescription rates, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMS).
Discussion:
AMS interventions are needed to help reduce inappropriate antibiotic prescribing for ARIs in general practice settings. The findings of this study will inform a hybrid type 3 implementation trial.
Trial Registration:
Registered prospectively with the Australian and New Zealand Clinical Trial Registry (ACTRN12624001011572) on 20 August 2024.
Insights
This study explores the acceptability of an online Antimicrobial Stewardship (AMS) Toolbox for general practitioners to reduce antibiotic prescribing for acute respiratory infections (ARIs). Findings will guide future implementation trials for better antibiotic use in primary care.
Area of Science:
- General Practice
- Antimicrobial Stewardship
- Implementation Science
Background:
- Antimicrobial resistance is a global health crisis driven by antibiotic misuse.
- Antibiotics are frequently prescribed for viral acute respiratory infections (ARIs) in Australian general practice.
- Effective antimicrobial stewardship (AMS) interventions are crucial for primary care settings.
Purpose of the Study:
- To evaluate the acceptability of a redesigned workflow and an AMS Toolbox for delivering AMS interventions in general practice.
- To assess the usability of an AMS Toolbox for accessing clinical data and AMS resources for ARIs.
- To inform a future hybrid type 3 implementation trial.
Main Methods:
- A 3-month, single-arm, pragmatic exploratory mixed-methods study in New South Wales, Australia.
- Involved 4-6 general practices, 12 general practitioners (GPs), 6-8 practice staff, and 50-100 patients.
- Utilized an online AMS Toolbox with resources, training, and a reminder card; data collected via surveys and focus groups.
Main Results:
- The primary outcome is the acceptability of the AMS Toolbox among GPs, practice staff, and patients.
- Secondary outcomes include recruitment rates, qualitative feedback, resource utilization, antibiotic prescribing patterns, and patient-reported outcomes and experiences.
- Data collection focuses on understanding the practical implementation of AMS interventions in primary care.
Conclusions:
- Antimicrobial stewardship interventions are essential to curb inappropriate antibiotic prescribing for ARIs in general practice.
- This study's findings will provide critical insights for designing and implementing effective AMS strategies in primary care.
- The results will directly inform a subsequent hybrid type 3 implementation trial to optimize AMS practices.
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