Antibiotic stewardship in general practice: a scoping review of the component parts

Talk Code: 
2C.4a
Presenter: 
Lesley Hawes
Twitter: 
Co-authors: 
Associate Professor Kirsty Buising, Professor Danielle Mazza
Author institutions: 
Department of General Practice, Monash University, National Centre for Antimicrobial Stewardship, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Victorian Infectious Diseases Service, Royal Melbourne Hospital

Problem

Antimicrobial stewardship (AMS) may be defined as “a coherent set of actions which promote using antimicrobials responsibly”. AMS can be established at an organisation or healthcare system level. Currently, we lack a comprehensive healthcare system framework for AMS in general practice. Identifying the component parts of a framework for AMS in general practice is an essential step towards developing a coherent strategy that can be effectively implemented and will highlight current gaps and priorities for AMS. The aim of this scoping review is to identify component parts of AMS in general practice to inform a framework which may be used to guide activity in this health care context.

Approach

The Joanna Briggs Institute reviewer’s manual was used to guide the scoping review method. Six medical databases and five international websites were searched for AMS frameworks applicable to general practice.

Inclusion criteria

Population: General practitioners (GPs) in community-based general practice.

Concept: Identification of the component parts from an AMS framework for general practice. The AMS framework should be integrated into the health system.

Context: General practice antibiotic prescribing in a country where antibiotics are primarily available by prescription from a registered provider.

Types of studies: All eligible full-text publications were included.

Language: English.

 

Findings

The database searches returned 2,112 records. After removal of duplicates and screening, five papers were selected. These were added to four papers identified by snowballing, one from a personal library, and six papers selected from the website searches. Preliminary findings from the 16 papers indicate the components required for an AMS framework in general practice are: 1. National leadership with input from GP professional bodies and funding. 2. Education for the community and prescribers. 3. Regulatory with restriction on antibiotic choice, planning for the release of new antibiotics and prescriber accreditation. 4. Consultation support with prescribing guidelines, appropriate diagnostic testing, patient information including decision aids, and communication skills training. 5. Pharmacy support with timely supply, review and advice, unit dispensing and disposal. 6. Monitoring – use of data to monitor antibiotic prescriptions, pathogen resistance, patient outcomes; and provision of useful feedback to prescribers. Limitation: This framework needs input from key stakeholders to provide information on implementability and validity.

Consequences

This review highlights a framework for AMS in general practice which will support GPs to safely reduce antibiotic prescribing.

Submitted by: 
Lesley Hawes
Funding acknowledgement: 
This research was funded by the National Health and Medical Research Council (NHMRC, Grant No. 1079625 to the National Centre for Antimicrobial Stewardship). The NHMRC had no participation in this review.