A tool to stem the antimicrobial tide

As antimicrobial resistance continues to pose a ‘growing threat to global health’, Australian researchers are trialling what they hope will be a simple but empowering tool to help GPs to stem the tide quickly, easily, and from their computers.
 
The Optimal Implementation of Antimicrobial Stewardship in General Practice (OPTIMAS-GP) trial is evaluating the effectiveness of an antimicrobial stewardship (AMS) toolbox for use by GPs during consultations.
 
The trial, which is supported by the RACGP, involves primary healthcare researchers from the University of Wollongong, Monash University, the University of Tasmania and Bond University, as well as GPs and pharmacists.
 
In 2023, Australia’s antibiotic use was about 10% higher than the OECD average. And with GPs providing almost nine out of 10 prescriptions for antibiotics, it’s clear that GPs are key to addressing antimicrobial resistance, says OPTIMAS-GP study lead and GP, Professor Andrew Bonney.
 
Professor Bonney told newsGP that what often unfolds in a consultation is ‘not about a lack of knowledge’, but the ‘complex environment’ GPs often find themselves in.
 
‘The reasons why more antibiotics get prescribed in general practice than the guidelines recommend are very complex,’ he said.
 
‘It’s not really about GPs not having the knowledge or the skills, because they do, but it’s complicated in a situation where you have patients who are unwell and wanting something to help make them feel better, and the GP is feeling obliged to try and help them some way or another.
 
‘There are feelings of uncertainty – “what goes wrong if this person actually does have a significant bacterial infection, and I don’t treat it?”.
 
‘Sometimes it’s quite difficult to let a patient out of the room without a script for antibiotics, even if you know in your heart of hearts, they don’t really need it.’
 
The AMS toolbox is a collation of evidence-based, reputable online resources that GPs can easily access during a consultation, from sources such as the Australian Commission on Safety and Quality in Health Care and the UK’s NICE guidelines.  
 
These include shared decision-making resources to use with patients, clinical decision support tools, such as online algorithms and flow charts to use with patients to demonstrate why they don’t need antibiotics, and information on delayed prescribing.
 
‘All of those things have been shown to significantly reduce antibiotic use,’ Professor Bonney said.
 
‘So, if they’re going to use a delayed script, or there’s some symptom control that they can use, or they need access to some of those clinical decision support tools, it’s all there in the one spot.
 
‘At the moment, these things are scattered all over the place on the internet, so these are just in a single spot where you can either access them directly, or download and print.’
 
The toolbox also provides data back to the researchers, as GPs record which resources they are using, and whether they have prescribed antibiotics.
 
‘We can then provide reports back to the GPs, so they can very quickly see how they’re going with antibiotic prescribing,’ he said.
 
The OPTIMAS-GP program will run for five years, with GPs and practices remunerated for their time.
 
The first trial, or ‘wave’, is already underway with 18 GPs from six practices, who have already completed their five months of using the tool.
 
The research team is actively recruiting for the second wave of the program, due to begin in July. For more information, visit the OPTIMAS- GP website.
 
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antibiotics antimicrobial resistance antimicrobial stewardship GP research GP training