Statewide Antimicrobial Stewardship Program, Queensland Health, Brisbane, Australia.
UQ Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Australia.
BMC Fam Pract. 2020 Jul 8;21(1):134. doi: 10.1186/s12875-020-01191-0.
Clinicians who work in primary care are potentially the most influential healthcare professionals to address the problem of antibiotic resistance because this is where most antibiotics are prescribed. Despite a number of evidence based interventions targeting the management of community infections, the inappropriate antibiotic prescribing rates remain high.
The question is how can appropriate prescribing of antibiotics through the use of Antimicrobial Stewardship (AMS) programs be successfully implemented in primary care. We discuss that a top-down approach utilising a combination of strategies to ensure the sustainable implementation and uptake of AMS interventions in the community is necessary to support clinicians and ensure a robust implementation of AMS in primary care. Specifically, we recommend a national accreditation standard linked to the framework of Core Elements of Outpatient Antibiotic Stewardship, supported by resources to fund the implementation of AMS interventions that are connected to quality improvement initiatives. This article debates how this can be achieved. The paper highlights that in order to support the sustainable uptake of AMS programs in primary care, an approach similar to the hospital and post-acute care settings needs to be adopted, utilising a combination of behavioural and regulatory processes supported by sustainable funding. Without these strategies the problem of inappropriate antibiotic prescribing will not be adequately addressed in the community and the successful implementation and uptake of AMS programs will remain a dream.
在初级保健领域工作的临床医生可能是最有影响力的医疗保健专业人员，可以解决抗生素耐药问题，因为大多数抗生素都是在这里开的。尽管有许多针对社区感染管理的基于证据的干预措施，但不合理的抗生素处方率仍然很高。
问题是如何通过使用抗菌药物管理（AMS）计划在初级保健中成功实施适当的抗生素处方。我们讨论了一种自上而下的方法，结合使用多种策略来确保社区中 AMS 干预措施的可持续实施和采用，以支持临床医生并确保在初级保健中实施强有力的 AMS。具体而言，我们建议建立一个与门诊抗生素管理核心要素框架相关联的国家认证标准，并提供资源来资助与质量改进计划相关的 AMS 干预措施的实施。本文讨论了如何实现这一目标。该文件强调，为了支持在初级保健中可持续采用 AMS 计划，需要采用类似于医院和后期护理环境的方法，结合行为和监管过程，由可持续资金支持。如果没有这些策略，社区中不合理的抗生素处方问题将无法得到充分解决，AMS 计划的成功实施和采用仍将是一个梦想。
