Submission to Developing a National Antimicrobial Resistance Strategy for Australia 5 November 2014
details Name of Organisation The Royal Australian College of General Practitioners () Postal Address 100 Wellington Parade East Melbourne, Victoria 3002 Legal Status Not for profit ABN 34 000 223 807 Key Contact Person and Contact Details Mr Stephan Groombridge Program Manager, Quality Care 03 8699 0544 stephan.groombridge@racgp.org.au Submission 2
1 The The Royal Australian College of General Practitioners () is Australia s largest professional membership body for general practitioners (GPs). With over 28,000 members across Australia, the works to support the profession through defining the standards for quality care, developing guidelines and resources, delivering education and training and advocating on behalf of general practices and general practitioners to promote the importance of a safe, quality and holistic approach to patient care. Introduction The recognises antimicrobial resistance (AMR) as a significant global health issue. A unified and strategic approach to addressing the problem is required and we commend the Government on the approach it has taken to date. The also recognises the role of general practice in efforts to maintain the effectiveness of antibiotics. As such, the is keen to work collaboratively with the Department of Health and other bodies to ensure general practice is equipped with the infrastructure, skills and resources to respond to this issue. We make the following comments on the discussion document and the proposed actions. 2- Strategy goal and objectives We believe the proposed goal is realistic and areas of focus are appropriate. 4 - Infection Prevention and Control The has led the profession in its response to infection prevention and control. As the discussion document describes, infection prevention and control measures are a key component of the Standards for general practice. Criterion 5.3.3 of the Standards is: Healthcare associated infections. Our practice has systems that minimise the risk of healthcare associated infections. To assist GPs and other staff implementing procedures involving infection prevention and control, the has produced (with support from the Department of Health) the Infection Prevention and Control Standards. With approximately 70% of general practices accredited against the Standards for general practices, the community can be reassured that general practice has appropriate systems in place to mitigate and control the spread of infection. In addition to the above resources, the has also produced Medical care of older persons in residential aged care facilities (the silver book). GPs play the major role in the provision of health care in aged care facilities and the silver book includes guidance on infection control and the treatment of infections. The s existing resources and systems are well recognised and respected and we would welcome discussion on how these might be further utilised and promoted as part of a national response to AMR. 5 - Surveillance Optimising and improving data collection on antibiotic use is crucial, as is improving and expanding the collection and evaluation of data on the appropriateness of antibiotic usage in all health care settings. is open to exploring how GPs can play a role in any National or local surveillance systems. Surveillance systems must reflect the realities of the general practice setting.
2 6 - Antimicrobial Stewardship To be successful and sustainable, stewardship programs need to be supported and multifaceted. Because of the complexity and variety of general practice, no single approach will succeed independently. Practices and GPs need to be supported with the infrastructure, skills, knowledge and tools to implement stewardship. A suite of complementary resources would provide the multifaceted approach that is likely to support and sustain change. We would envisage such an approach would include: Practice level resources suggested practice policies, clinical audit tools, and advice on organisations that can assist with continued quality improvement in antimicrobial stewardship. Practice level programmes - interventions that reduce inappropriate use of antimicrobial. One such programme which seems to have had success in the UK was the 4C strategy to reduce 3 rd generation Cephalosporins, C0-amoxicillin, ciproxin, and clindamycin. It appears simple and effective. Shared decision making tools access to such tools will support the therapeutic relationship. Point of care testing (POCT) - POCT holds great promise and the would encourage efforts to speed up the development and adoption of appropriate POCT prior to antibiotic use. Personalised prescribing audits tailored to practices and GPs. The is eager to use its expertise in these areas and explore with the Department how implementation of a GP based antimicrobial stewardship programme may be implemented. The s clinical indicators initiative, which is developing a dashboard set of indicators for Australian general practice, looked at incorporating an indicator on antimicrobial usage but this proved difficult to implement for a number of reasons. We would be keen to revisit this as part of a broader response to AMR issues. We also recognise the place of initiatives such as the NPS s MedicineInsight program. An expanded MedicineInsight program could play a role in underpinning practices quality improvement initiatives. 7 - Communication and Education Antimicrobial resistance is specifically included in the Curriculum for Australian General Practice under the quality use of medicines component. Strong foundations, therefore, already exist to further develop and build on the existing knowledge and skill base of GPs. This is supported by a recent survey of 730 GPs conducted by the NPS which found that GPs are performing well in recommending symptomatic management of common viral infections, rather than antibiotics. GPs are required to undertake ongoing professional development. Providing education opportunities in the area of AMR should be a key component to any AMR strategy. Education can be provided in a number of formats to meet the needs to GPs, such as online modules through the s gplearning platform, through face to face workshops, or through question and answer activities linked with our academic journal Australian Family Physician (AFP), and check, our independent learning program. Education might cover topics such as communication skills, prescribing best practice, and infection control. Delayed prescribing is one strategy that has proven to be effective and education and practical tools in this should be a priority.
3 Practical tools and guides that provide advice on evidence based strategies such as delayed prescribing, managing diagnostic uncertainty, and appropriate prescribing for common conditions will be important. Because maintaining a strong doctor patient therapeutic relationship is essential to the effectiveness of general practice, education and resources also need to be targeted at patients and the public. Patient pressure is often cited as one reason why doctors prescribe. Public awareness campaigns will be crucial to support efforts in general practice to reduce inappropriate patient requests for antibiotics. Patient resources and shared decision aids should all form part of a comprehensive package. The existing NPS symptom management pads will complement these efforts. Information should reflect the cultural dimensions to antibiotic use in some communities. The feels the development of verbal scripts to address inappropriate patient requests for antibiotics would also be a positive initiative. 8 - International Engagement The suggestions in the section seem sensible. 9 - Research and Development The suggestions in this section seem sensible. 10 - Governance The existing regulatory framework in general practice is effective in ensuring high quality and safe care. As described above, general practice has already proactively responded to the issues of AMR through its Practice Standards and Education Curriculum. Whilst the would be open to discussion on the merits of including specific AMR criteria within our Standards, in general we feel that the standards must not become too prescriptive. This risks them becoming too burdensome and bureaucratic which will in turn have a negative impact on quality. We do however believe that clinical governance at a practice level could be supported to improve AMR issues. It is crucial that initiatives reflect the realities of general practice and the constraints the current funding model puts on GPs. Increasing regulatory burden usually come with an additional cost and time burden for the GP which negatively impact on their ability to provide high quality care in other areas. Conclusion We welcome the Government s focus on AMR and look forward to constructive relationship with the Department of Health and other bodies in addressing the complex challenges it presents.