Evaluating antimicrobial prescribing practice in Australian remote primary healthcare clinics

Jarrod de Jong; Tobias Speare; Fabian Chiong; Lloyd Einsiedel; Bronwyn Silver; Debra Gent; Steven Tong; Danny Tsai

doi:10.1016/j.idh.2021.02.001

Evaluating antimicrobial prescribing practice in Australian remote primary healthcare clinics

Infect Dis Health. 2021 Aug;26(3):173-181. doi: 10.1016/j.idh.2021.02.001. Epub 2021 Mar 17.

Authors

Jarrod de Jong¹, Tobias Speare², Fabian Chiong³, Lloyd Einsiedel³, Bronwyn Silver¹, Debra Gent¹, Steven Tong⁴, Danny Tsai⁵

Affiliations

¹ Central Australian Aboriginal Congress, 14 Leichhardt Terrace, Alice Springs, 0870, Northern Territory, Australia.
² Centre for Remote Health, Flinders University, Corner Simpson & Skinner Streets, Alice Springs, 0870, Northern Territory, Australia.
³ Department of Medicine, Alice Springs Hospital, Gap Road, Alice Springs, 0870, Northern Territory, Australia.
⁴ Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, 3000, Victoria, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, 3000, Victoria, Australia.
⁵ Centre for Remote Health, Flinders University, Corner Simpson & Skinner Streets, Alice Springs, 0870, Northern Territory, Australia; University of Queensland Centre for Clinical Research, Royal Brisbane & Women's Hospital Campus, Building 71/918, Herston, 4092, Queensland, Brisbane, Queensland, Australia; Pharmacy Department, Alice Springs Hospital, Gap Rd, Alice Springs, 0870, Northern Territory, Australia. Electronic address: danny.tsai@flinders.edu.au.

PMID: 33744202
DOI: 10.1016/j.idh.2021.02.001

Abstract

Background: Inappropriate antimicrobial prescribing contributes to the emergence of antimicrobial resistance. Gaps exist in the understanding of antimicrobial prescribing in the remote setting. We aimed to assess adherence to guidelines and appropriateness of antimicrobial prescribing in Central Australia.

Methods: A retrospective study assessing antimicrobial prescriptions in ten Aboriginal clinics (three in remote communities and seven in regional centre) using a validated evaluation tool. Antimicrobials prescribed between 1 January-31 December 2018 were randomly selected for inclusion into the study. The main outcome measures were the rates of guideline adherence and inappropriate prescribing.

Results: A total of 180 prescriptions were included (96.1% Aboriginal, 32.2% male). Ninety-nine (55.0%) prescriptions were written by general practitioners (GPs), 57 (31.7%) by nurses and 24 (13.3%) by others. Forty-three (25.7%) assessable prescriptions were deemed inappropriate and 75 (44.4%) did not adhere to guidelines. Prescriptions written by GPs were less likely to adhere to guidelines, particularly GPs located in remote communities. The most common reasons for inappropriate prescribing were incorrect dosage/frequency and antimicrobial not indicated. Skin and soft-tissue infection was the commonest indication, with 29 of 41 (70.7%) prescriptions deemed appropriate. Prescriptions for lower respiratory-tract infection had the lowest rate of appropriateness, with one of seven prescriptions deemed appropriate (14.3%). Antimicrobials with the lowest rate of appropriateness were ciprofloxacin, amoxicillin-clavulanate and cefalexin, at 50%, 56%, and 62%, respectively.

Conclusion: A quarter of antimicrobial prescriptions written in select remote central Australian Aboriginal primary healthcare clinics were deemed inappropriate. The implementation of a comprehensive antimicrobial stewardship program is recommended.

Keywords: Aboriginal health; Antimicrobial; Antimicrobial resistance; Antimicrobial stewardship; Indigenous health; Remote health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Infective Agents* / therapeutic use
Antimicrobial Stewardship*
Australia
Female
Humans
Male
Primary Health Care
Retrospective Studies

Substances

Anti-Infective Agents