General Practitioners Antimicrobial Stewardship Programme Study (GAPS)

Poster on prescribing policy for antibiotics

This intervention will consist of displaying a poster-sized commitment letter in the GPs waiting room and/or examination room. The posted commitment letter, written at the eighth grade reading level and displayed in English emphasises GP commitment to guidelines, i.e. Therapeutic Guidelines: Antibiotic, for appropriate antibiotic prescribing and explains why antibiotics are not appropriate in many cases. 

A sample poster is available for you to review.

Patient information leaflet

This intervention will consist of an information leaflet that will provide more information to the patient about the poster-sized commitment letter in the GPs waiting room and/or examination room. 

View the Patient Information leaflet

Delayed antibiotic prescribing

Patients who present with acute respiratory infections (ARIs) will be evaluated by the GP. The GP will negotiate with the patient about management decisions for ARIs describing that very few people prescribed antibiotics will receive any benefit, and that benefit is of limited clinical relevance.

If antibiotics are not deemed necessary at the time of the consultation, the GP can discuss with the patient when they may be needed. The GP can choose to provide the patient with a delayed antibiotic prescription with advice to the patient to only have the prescription filled at a pharmacy after a few days if symptoms are not starting to settle or become more severe. A sticker will be applied to the prescription labelling it as a delayed prescription.

There are two booklets which can be utilised to facilitate your discussion with the patient about delayed antibiotic prescribing which can be downloaded from the following links:

• Caring for coughs: Your guide to managing chest infections
• Managing your respiratory tract infection

Pharmacists will be collaborating with GPs by educating patients about appropriate antibiotic use for the management of Acute Respiratory Infections when they are presented with a prescription that is labelled as a delayed antibiotic prescription.

Patient decision aids

Patient Decision Aids (PDAs) are brief summaries of evidence for the management of a condition. The decision aids have been developed to assist the patient to make an appropriate decision about their condition in conjunction with the GP. The PDAs are not substitutes for discussions with skilled healthcare professionals. They are intended to be used in consultations to encourage better informed, patient-focused decision-making. The precise approach to using a specific PDA may vary depending on the clinician and the patient. 

How to use PDAs

Communicaton

Online training in enhanced communication skills to facilitate the appropriate management of the patient’s illness during consultation will be provided. This will enable the clinician and patient to participate jointly in making a health decision, having discussed the options and their benefits and harms, and having considered the patient’s values, preferences and circumstances.

The communication training package will be offered in combination with background information on the problem of antimicrobial resistance in primary care and the effectiveness of antibiotics for most commonly presenting ARIs.

This is a web-based module for General Practitioners which has been developed by the INTRO team in the UK led by Professor Paul Little and Professor Lucy Yardley from the University of Southampton, and Professor Chris Butler from Cardiff University. It has been adapted for the Australian general practice context by the ChAP team led by GPs Mieke van Driel and Parker Magin.  It has been trialled in Australia by GP registrars and their supervisors  (GPs). The ChAP study includes an educational package for GP registrars in the form of a workshop in addition to this web-based module. The workshop will not be part of the training package that is being offered to the GPs participating in the ‘Antimicrobial Stewardship and Infection Prevention and Control Initiatives in General Practice’ study.

The web-based module includes two booklets which can be accessed in the online training module or downloaded from the following links:

• Caring for coughs: Your guide to managing chest infections
• Managing your respiratory tract infection

This activity has been approved by the RACGP QI&CPD Program for 2 Category 2 points for 2014-2016 Triennium. The Activity Code No: 30135

To access the online training module contact m.avent@uq.edu.au

Point of care test C-reactive protein (CRP)

Point of care test C-reactive protein (CRP) is performed on a finger prick blood sample and the result is available during patient consultation and can, therefore, guide antibiotic use. 

C-reactive protein (CRP) is an acute-phase protein synthesised in the liver. Production of CRP is rapidly induced in response to infection, inflammation and tissue injury. The test is performed on a finger prick blood sample and the result is available during patient consultation and can, therefore, guide antibiotic use. The CRP test is widely used in some European primary care settings(1) and the test has been shown to significantly reduce antibiotic prescribing for patients with ARIs (RR 0.54, 95% CI 0.42-0.69).(2)  A newly published Cochrane review concluded that CRP used as an adjunct to a doctor’s clinical examination can reduce antibiotic use for patients with ARIs in primary care.(3)

View more information about how to use CRP testing in general practice within consultations for acute respiratory tract infections.

By reviewing the material GPs will be eligible to claim 2 (Category 2) points in QI&CPD Program for the 2014–16 triennium. The  Activity ID number is 32216.

1. Howick J, Cals JW, Jones C, Price CP, Pluddemann A, Heneghan C, et al. Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA. BMJ Open. 2014; 4: e005611.
2. Little P, Stuart B, Francis N, Douglas E, Tonkin-Crine S, Anthierens S, et al. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet. 2013; 382: 1175-82.
3. Aabenhus R, Jensen JU, Jorgensen KJ, Hrobjartsson A, Bjerrum L. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database Syst Rev. 2014; 11: CD010130.

Infection Control strategies in GP settings

There are very few data about effective Infection control strategies in the GP setting. Surveillance anterior nasal and throat swabs will be taken from General Practice staff and patients to define rates of transmission in staff and community members attending the GP practice for consultation with non-infectious complaints. This will help define what ICP protocols need to be implemented in GP settings.