1. Antimicrobial stewardship in the primary care setting: from dream to reality?
- Author
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Avent ML, Cosgrove SE, Price-Haywood EG, and van Driel ML
- Subjects
- Decision Support Systems, Clinical, Drug Resistance, Microbial, Guideline Adherence, Humans, Practice Guidelines as Topic, Practice Patterns, Physicians' standards, Ambulatory Care economics, Ambulatory Care legislation & jurisprudence, Anti-Bacterial Agents therapeutic use, Antimicrobial Stewardship methods, Antimicrobial Stewardship organization & administration, Inappropriate Prescribing prevention & control, Primary Health Care methods, Primary Health Care organization & administration, Primary Health Care standards
- Abstract
Background: Clinicians who work in primary care are potentially the most influential healthcare professionals to address the problem of antibiotic resistance because this is where most antibiotics are prescribed. Despite a number of evidence based interventions targeting the management of community infections, the inappropriate antibiotic prescribing rates remain high., Discussion: The question is how can appropriate prescribing of antibiotics through the use of Antimicrobial Stewardship (AMS) programs be successfully implemented in primary care. We discuss that a top-down approach utilising a combination of strategies to ensure the sustainable implementation and uptake of AMS interventions in the community is necessary to support clinicians and ensure a robust implementation of AMS in primary care. Specifically, we recommend a national accreditation standard linked to the framework of Core Elements of Outpatient Antibiotic Stewardship, supported by resources to fund the implementation of AMS interventions that are connected to quality improvement initiatives. This article debates how this can be achieved. The paper highlights that in order to support the sustainable uptake of AMS programs in primary care, an approach similar to the hospital and post-acute care settings needs to be adopted, utilising a combination of behavioural and regulatory processes supported by sustainable funding. Without these strategies the problem of inappropriate antibiotic prescribing will not be adequately addressed in the community and the successful implementation and uptake of AMS programs will remain a dream.
- Published
- 2020
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