Antibiotics | Notable Study Reveals Implementation Determinants of Antimicrobial Stewardship Strategies for Adult Acute Respiratory Infections in Community Settings

This study, using an experience-based co-design approach, thoroughly investigates key factors influencing the implementation of antimicrobial stewardship strategies in general practice, providing important insights for optimizing antibiotic use and reducing antimicrobial resistance.

 

Literature Overview
This paper 'Determinants of Implementation of Antimicrobial Stewardship Interventions for Managing Community Adult Acute Respiratory Infections: Qualitative Analysis from the OPTIMAS-GP Study Co-Design Phase' published in the journal Antibiotics reviews factors affecting implementation of antimicrobial stewardship strategies in Australian general practice, focusing on feasibility and acceptability of shared decision-making tools, delayed prescriptions, and C-reactive protein point-of-care testing.

Background Knowledge
Acute Respiratory Infections (ARIs) represent a primary reason for global antimicrobial prescriptions despite most infections being viral in nature, contributing to inappropriate antibiotic use. This behavior significantly drives antimicrobial resistance (AMR). While antimicrobial stewardship (AMS) strategies have been widely implemented in hospital settings, their adoption in general practice remains in early stages. Although strategies like shared decision-making (SDM) tools, delayed prescriptions (DP), and point-of-care testing (PoCT) theoretically support AMS, practical implementation faces multiple barriers including patient expectations, time constraints, and health literacy challenges. This study employs Experience-Based Co-Design methodology to gather feedback from patients and healthcare professionals, establishing theoretical foundations for future AMS implementation strategies and emphasizing the necessity of patient-centered tools, clear guidance, and cross-professional collaboration.

 

 

Research Methods and Experiments
This qualitative study utilized the Experience-Based Co-Design (EBCD) framework through three rounds of online focus group discussions involving 10 healthcare professionals (GPs, pharmacists, microbiologists, nurses) and 10 patients with prior ARI management experiences in general practice. Researchers explored feasibility and acceptability of shared decision-making tools, delayed prescriptions, and PoCT-CRP in primary care settings, while thematic analysis identified key implementation determinants. Behavioral determinants were analyzed using Capability-Opportunity-Motivation (COM-B) and Theoretical Domains Framework (TDF), providing evidence-based implementation strategies.

Key Conclusions and Perspectives

• Patient acceptability and engagement are influenced by expectations regarding antibiotic use, trust, and personalized care, while shared decision-making tools and delayed prescription strategies are difficult to implement effectively under time pressure and health literacy constraints
• System-level factors such as continuity of care, practice culture, and resource availability significantly impact AMS implementation, with fragmented care and changing practice patterns undermining therapeutic alliances and patient engagement
• Delayed prescription strategies, though practical, may cause patient confusion requiring clear guidance and cross-professional collaboration for optimal implementation
• While cautiously accepted, PoCT-CRP integration into clinical workflows raises concerns among healthcare professionals about potential overreliance on test results, suggesting selective use to preserve clinical judgment
• Findings emphasize the need for system-supported customized AMS strategies including co-designed patient-friendly tools, enhanced GP-pharmacist collaboration, and solutions for PoCT integration barriers

Research Significance and Prospects
This study provides behaviorally grounded implementation strategies for optimizing antibiotic use in primary care through systematic analysis of implementation challenges. Future research should focus on developing locally adapted AMS tools and enhancing feasibility through system-level interventions (training, audit, and feedback mechanisms). The findings offer valuable references for implementing similar AMS strategies in global primary care settings.

 

 

Conclusion
This study systematically analyzed four key implementation themes in Australian general practice: patient acceptability, system practices, prescription management, and diagnostic challenges. While shared decision-making tools, delayed prescriptions, and PoCT-CRP theoretically support antimicrobial stewardship, practical implementation encounters multiple barriers including time constraints, low health literacy, and workflow integration difficulties. The findings highlight the necessity of co-designed personalized AMS resources with system support, and strengthened cross-professional collaboration to ensure patient safety and rational antibiotic use. These insights provide critical references for global antimicrobial management in primary care and establish foundational implementation strategies within behavior change theory frameworks.

 

Margaret Jordan, Mary Burns, Colin Cortie, Stephen Barnett, and Andrew Bonney. Determinants of Implementation of Antimicrobial Stewardship Interventions for Managing Community Adult Acute Respiratory Infections: Qualitative Analysis from the OPTIMAS-GP Study Co-Design Phase. Antibiotics.