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Inappropriate antimicrobial prescribing contributes to increasing antimicrobial resistance. An antimicrobial stewardship (AMS) program in the form of quality improvement activities that included audit and feedback, clinical decision support and education was developed to help optimise prescribing in general practice. The aim of this study was to evaluate the implementation of this program (Guidance GP) in three general practices in Melbourne, Australia, between November 2019 and August 2020. Thirty-one general practitioners (GPs) participated in the program, with 11 GPs and three practice managers participating in follow-up focus groups and interviews to explore the acceptability and feasibility of the program. Our findings showed that the quality improvement activities were acceptable to GPs, if they accurately fit GPs' decision-making process and workflow. It was also important that they provided clinically meaningful information in the form of audit and feedback to GPs. The time needed to coordinate the program, and costs to implement the program were some of the potential barriers identified. Facilitators of success were a "whole of practice" approach with enthusiastic GPs and practice staff, and an identified practice champion. The findings of this research will inform implementation strategies for both the Guidance GP program and AMS programs more broadly in Australian general practice, which will be critical for general practice participation and engagement.

Background: An objective of the Australian government's 'National Antimicrobial Resistance Strategy' is the auditing and monitoring of antimicrobial prescribing quality. This helps identify targets for improvement and assist in the evaluation of any implemented changes. In a pilot study, the GP NAPS audit tool extracted de-identified data from general practice electronic medical records (EMRs) to allow the assessment of community antimicrobial prescribing quality. This study validates the GP NAPS audit tool for making these assessments. Aim/Objectives: To validate the GP NAPS audit tool against a manual in-practice audit. Method(s): Antimicrobial prescription details were extracted by the GP NAPS audit tool over a 2-week period in November 2019 across three general practices in Melbourne. Data extracted included patient demographics, details of the antimicrobial prescription, and microbiology requests. A baseline audit of appropriateness and guideline-compliance was assessed by a team of experts based on this data (n=217). For the validation, these assessments will be compared against an in-practice, blinded, manual audit of the same prescriptions, with access to all clinical information in the EMR. Statistical analysis comparing the outcomes of both audits will generate sensitivity, specificity, PPV, and NPV values to quantify the validity of the GP NAPS audit tool. Further analysis will examine reasons for any differences. Finding(s): The study is currently underway, with data collection to be completed in March 2020. Implications: Validation will establish the veracity and reliability of GP NAPS audit results, and support its wider adoption as a national program to support community antimicrobial stewardship initiatives.