PRP098: Guidance GP: Pilot of a quality improvement program for antimicrobial stewardship in general practice

Jo-Anne Manski-Nankervis, PhD, BSc, MBBS, FRACGP; Ron Cheah, BPharm, GradCertPharmPrac, MPharmPrac; Malcolm Clark, FRCGP, MBChB; Ruby Biezen, PhD, BSc, MAppSc; kirsty buising, MD, MBBS, MPH

Abstract

Context: Australia is a high consumer of antibiotics per capita relative to the rest of the world; the majority of these are prescribed in general practice. Overuse of antibiotics contributes to antimicrobial resistance, resulting in antibiotics not being effective when they are required. As a result, there have been calls for a coordinated, national antimicrobial stewardship program for general practice. Objective: Evaluate a pilot quality improvement program (Guidance GP) for antimicrobial prescribing in general practice consisting of audit and feedback (General Practice National Antimicrobial Prescribing Survey; GP NAPS) and a clinical decision support (CDS) tool facilitating access to national practice guidelines (Therapeutic Guidelines (eTG)). Study Design: Mixed methods study Setting or Dataset: General practice clinics. Population studied: Three general practices in metropolitan Melbourne using Best Practice as their electronic medical record (EMR) system. Intervention/Instrument: (1) The GP NAPS 2-week audit will be conducted at two time-points: November 2019 and July 2020. Quality improvement (QI) support is provided by North Western Melbourne Primary Health Network. A subscription to eTG will be provided to all participants. The guidelines can be accessed via website or through a CDS “button” in the EMR. Outcome Measures: (1) Number of antimicrobial prescriptions; proportion of prescriptions that are (a) considered appropriate for indication, and (b) compliant with eTG (2) General Practitioners’ (GP) perspectives on acceptability and usability of GP NAPS and CDS tools and results; (3) barriers and facilitators of implementation and participation Results: 41 GPs participated across three practices (range 5 to 21). 231 antimicrobial prescriptions were assessed in the first audit period. The most common indications were skin and soft tissue infections (27%), ear, nose and throat infections (23%) and respiratory tract infections (13%). 86/231 (37%) of prescriptions were compliant with eTG; 84/231 (63%) were adjudicated as appropriate. QI activities reported by GPs included development of a practice prescribing policy, increased use of clinical guidelines, updating prescription management systems, considering delayed prescribing and use of shared decision-making aids. Installation of the CDS tool and focus groups have been delayed due to COVID-19 but will be completed by the end of 2020.

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