A Novel GPPAS Model: Guiding the Implementation of Antimicrobial Stewardship in Primary Care Utilising Collaboration between General Practitioners and Community Pharmacists

Sajal K Saha; Karin Thursky; David C M Kong; Danielle Mazza

doi:10.3390/antibiotics11091158

A Novel GPPAS Model: Guiding the Implementation of Antimicrobial Stewardship in Primary Care Utilising Collaboration between General Practitioners and Community Pharmacists

Antibiotics (Basel). 2022 Aug 27;11(9):1158. doi: 10.3390/antibiotics11091158.

Authors

Sajal K Saha^{1

2

3

4}, Karin Thursky³, David C M Kong^{1

3

5

6}, Danielle Mazza^{2

3}

Affiliations

¹ School of Medicine, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia.
² Department of General Practice, The School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3168, Australia.
³ National Centre for Antimicrobial Stewardship (NCAS), Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, VIC 3000, Australia.
⁴ Public Health Unit, Geelong Centre for Emerging Infectious Disease, Barwon Health, Geelong, VIC 3220, Australia.
⁵ Centre for Medicine Use and Safety, Monash University, 381 Royal Parade Parkville, Melbourne, VIC 3052, Australia.
⁶ Pharmacy Department, Ballarat Health Services, Ballarat, VIC 3350, Australia.

Abstract

Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is central to implement antimicrobial stewardship (AMS) programmes in primary care. This study aimed to design a GP/pharmacist antimicrobial stewardship (GPPAS) model for primary care in Australia. An exploratory study design was followed that included seven studies conducted from 2017 to 2021 for the development of the GPPAS model. We generated secondary and primary evidence through a systematic review, a scoping review, a rapid review, nationwide surveys of Australian GPs and CPs including qualitative components, and a pilot study of a GPPAS submodel. All study evidence was synthesised, reviewed, merged, and triangulated to design the prototype GPPAS model using a Systems Engineering Initiative for Patient Safety theoretical framework. The secondary evidence provided effective GPPAS interventions, and the primary evidence identified GP/CP interprofessional issues, challenges, and future needs for implementing GPPAS interventions. The framework of the GPPAS model informed five GPPAS implementation submodels to foster implementation of AMS education program, antimicrobial audits, diagnostic stewardship, delayed prescribing, and routine review of antimicrobial prescriptions, through improved GP-CP collaboration. The GPPAS model could be used globally as a guide for GPs and CPs to collaboratively optimise antimicrobial use in primary care. Implementation studies on the GPPAS model and submodels are required to integrate the GPPAS model into GP/pharmacist interprofessional care models in Australia for improving AMS in routine primary care.

Keywords: GP-pharmacist collaboration; antimicrobial stewardship; implementation model; primary care.

Grants and funding

This study was built on a Ph.D. project which received no specific research grant from any funding agency in the public, commercial, or not for profit sectors. S.K.S. was supported by the Monash University International Post Graduate Scholarship, Monash Graduate Scholarship, travel grant awards from the 2018 North American Primary Care Research Group (NAPCRG), 2020 European Society of Clinical Microbiology and Infectious Disease (ESCMID), and 2021 Australasian Academic Primary care (AAAPC). S.K.S. received a post publication award 2021 from Monash University and a trainee award from Transdisciplinary Understanding and Training on Research Primary Health Care (TUTOR PHC) during this study. S.K.S. has been awarded the Jeff Cheverton scholar 2022 from the Deeble Institute for Health Policy Research for writing a policy brief on the current work to draw the attention of national AMS policymakers for future policy actions. In addition, S.K.S. has been awarded the executive dean health research fellowship award 2022 from Deakin University to continue doing implementation evaluation of the GPPAS model. Technical and statistical supports are provided by the Department of General Practice of Monash University, Australia and the School of Medicine, Deakin University, Australia.