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RESEARCH ARTICLE (Open Access)
Contents Vol 30(1)

Reducing antibiotic prescribing in general practice in Australia: a cluster randomised controlled trial of a multimodal intervention

Minyon L. Avent https://orcid.org/0000-0001-7228-2834 A B * , Lisa Hall https://orcid.org/0000-0002-9309-9315 C , Mieke van Driel D , Annette Dobson C , Laura Deckx D , Mahmoud Galal C , Malene Plejdrup Hansen https://orcid.org/0000-0002-8444-1369 E and Charles Gilks C
+ Author Affiliations
- Author Affiliations

A UQ Centre for Clinical Research, The University of Queensland, Herston, Qld, Australia.

B Queensland Statewide Antimicrobial Stewardship Program, Queensland Health, Herston, Qld, Australia.

C School of Public Health, The University of Queensland, Herston, Qld, Australia.

D General Practice, Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia.

E Center for General Practice at Aalborg University, Aalborg, Denmark.

* Correspondence to: m.avent@uq.edu.au

Australian Journal of Primary Health 30, PY23024 https://doi.org/10.1071/PY23024
Submitted: 1 April 2023  Accepted: 19 September 2023  Published: 17 October 2023

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

The health and economic burden of antimicrobial resistance (in Australia is significant. Interventions that help guide and improve appropriate prescribing for acute respiratory tract infections in the community represent an opportunity to slow the spread of resistant bacteria. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed.

Methods

A cluster randomised trial was conducted comparing two parallel groups of 27 urban general practices in Queensland, Australia: 13 intervention and 14 control practices, with 56 and 54 general practitioners (GPs), respectively. This study evaluated an integrated, multifaceted evidence-based package of interventions implemented over a 6-month period. The evaluation included quantitative and qualitative components, and an economic analysis.

Results

A multimodal package of interventions resulted in a reduction of 3.81 prescriptions per GP per month. This equates to 1280.16 prescriptions for the 56 GPs in the intervention practices over the 6-month period. The cost per prescription avoided was A$148. The qualitative feedback showed that the interventions were well received by the GPs and did not impact on consultation time. Providing GPs with a choice of tools might enhance their uptake and support for antimicrobial stewardship in the community.

Conclusions

A multimodal package of interventions to enhance rational prescribing of antibiotics is effective, feasible and acceptable in general practice. Investment in antimicrobial stewardship strategies in primary care may ultimately provide the important returns for public health into the future.

Keywords: antibiotics, anti-infectives, antimicrobial stewardship, antimicrobials, community, cost effective, general practitioners, prescribing, qualitative feedback.

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