Oliver Stefanie Jane, Cush James, Ward Jeanette E
Pharmacy Department, Western Australia Country Health Service (WACHS)-Kimberley, Broome, WA, Australia.
Paediatrics Department, Western Australia Country Health Service (WACHS)-Kimberley, Broome, WA, Australia.
Front Public Health. 2017 Jul 12;5:158. doi: 10.3389/fpubh.2017.00158. eCollection 2017.
To support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS) Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing.
Finding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions) to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee.
Prescribing recommendations in a regional had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60%) about AMS risks in community prescribing. If feasible, prescribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee.
As AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform deliberations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting.
为了给在澳大利亚西北部偏远地区工作的医院和社区卫生专业人员的抗生素处方提供支持，2013年成立了一个多学科抗菌药物管理（AMS）委员会。该委员会通常专注于医院处方。在一年时间里，抗菌谱中磺胺甲恶唑/甲氧苄啶耐药率从9%令人不安地升至18%，这促使关注点转向社区处方。
发现相关研究匮乏后，我们首先调查了影响当地处方的背景因素。我们还设计了一项针对有与我们环境相关经验的专家的系统调查，使用结构化应答调查（12个问题）来更好地了解特定的AMS风险。利用这些发现，为AMS委员会制定了建议。
2014年12月，该地区的处方建议曾被更改。我们收到了15位专家中9位（60%）关于社区处方中AMS风险的全面回复。如果可行的话，处方审核也会很有价值。向AMS委员会提交了10条关于特定抗生素建议的建议。
在偏远地区加强AMS：由于澳大利亚的AMS委员会通常专注于医院处方，外部专家意见等新方法可以为关于社区处方的审议提供信息。我们的方法意味着这个AMS委员会能够在2017年对可能未意识到AMS风险的处方者使用的该地区进行组织审查时进行干预。这一经验证明了在偏远地区的背景下将AMS原则纳入社区处方的价值。
