Optimising antimicrobial stewardship in Australian primary care

Antibiotics – they’ve saved countless lives and are widely credited as one of the most important medical discoveries in human history. But what happens when they are misused and stop working?

The emergence of antimicrobial-resistant infections stands as one of the most significant health threats of our time. The continued inappropriate or overuse of antimicrobials has accelerated the development of antimicrobial resistance (AMR). AMR makes currently treatable infections become complex and life-threatening. 

Australia is one of the highest antimicrobials (antibiotic) prescribing countries in the developed world. Unnecessary use of antibiotics in the community significantly leads to develop antibiotic-resistant infections, and increase adverse side effects, and treatment costs. 

Dr Sajal Saha is one Australian researcher working to prevent this from happening. Dr Saha is part of the newly formed Deakin University and Barwon Health, Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR). Dr Saha has recently published an “Issues Brief” to bring attention of the care providers, stakeholders and policymakers to the issue for change.  

The briefing paper titled ‘Optimising antimicrobial stewardship in Australian primary care’ has been recently released by the Australian Healthcare and Hospitals Association’s (AHHA) Deeble Institute for Health Policy Research.   

The Australian Commission of Safety and Quality in Health Care (ACSQHC) has made a fact sheet on the issue highlighting 11 key recommendations presented in the issues brief. The North-Western Primary Health Network (PHN) has shared this brief with 40000 plus stakeholders.

Without action, the expected global costs of antimicrobial resistance will exceed $1 trillion by 2050. Preventing antimicrobial resistance requires the establishment of antimicrobial stewardship (AMS) programs in routine prescribing practices.

In Australia, AMS programs are well established in secondary and tertiary care but not within primary care despite more than 80% of antibiotics being prescribed in primary care. Estimates suggest that 30-50% of prescriptions are inappropriate either in choice of antibiotics, dose or duration of antibiotic therapy.   

There are multiple practical and systemic barriers to implementing AMS program in primary care. These include patient demand for antibiotics, diagnostic uncertainty, limited AMS training and a lack of GP-pharmacist collaborative health service model for optimising antibiotic use. Barriers to incorporating AMS programs in primary care must be addressed, and interprofessional collaboration between general practice and community pharmacy should be fostered. 

‘In order to start to overcome these barriers, both general practice and community pharmacy must be empowered to harness tools for better prescribing such as point-of-care testing and clinical decision support tools.’ says co-author and AHHA Chief Executive Kylie Woolcock. 

‘We also need to see improvements in data management in this area, as complete data on prescribing trends is crucial to assessing prescribing habits and informing policy priorities. 

‘New data collection platforms and improvements to the current health systems can enable real-time prescription monitoring, improve collaboration between GPs and community pharmacists, and patient outcomes. 

‘This issues brief proposes a national AMS implementation framework, and the GP-pharmacist collaborative antimicrobial stewardship (GPPAS) model required to improve AMS in primary care. ‘Recommendations are made to address gaps in current health systems structures, and policies that support GP-pharmacist collaboration for AMS and provide a defence against antimicrobial resistance (AMR) in primary care.’  

Future research and funding in the area are key to address AMR in primary care in Australia.  

Introducing The Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR)

The newly formed, CIIDIR is providing support for innovation of the novel GP/pharmacist antimicrobial stewardship (GPPAS) model in preventing AMR in Australian primary care. The novel GPPAS model involving point-of-care C-reactive protein testing is currently being funded through CIIDIR and The Institute for Mental and Physical Health and Clinical Translation (IMPACT) seed grants for pilot evaluation in GP-pharmacy co-located practices in Geelong regions in Victoria.

Dr Saha and Prof. Eugene Athan (Co-Director, CIIDIR) are co-leading the research program in collaboration with the National Centre for Antimicrobial Stewardship (Prof Karin Thursky) and Nuffield Department of Primary Care Health Sciences of Oxford University (Dr Oliver Van Hecke).  

About the authors:  

Dr Sajal Saha, 2022 Jeff Cheverton Memorial Scholar, Executive Dean Health Research Fellow, School of Medicine, Deakin University. E: sajal.saha@deakin.edu.au 

Adj A/Prof. Rebecca Haddock, Executive Director, Australian Healthcare and Hospitals Association. Email: rhaddock@ahha.asn.au