Why can’t they work together?

GP and pharmacist collaboration is vital to improve antimicrobial stewardship, but is it occurring? And what can be done to improve the situation?

Collaboration between the key frontline health workers – GPs and community pharmaicsts – has been identified as essential to improve the quality and safety of antimicrobial use in primary care.

However, new Australian research suggests collaboration is not always occurring, with a number of barriers and differences of attitude being identified. 

Researchers from a number of Victorian institutions conducted nationwide surveys of GPs and CPs across Australia during 2019.

Of 999 respondents (386 GPs and 613 pharmacists), they found that study GPs were comparatively  less supportive to GP–pharmacist collaborative antimicrobial audit (46.1% vs. 86.5%) model than were CPs. 

“Our findings suggest that the current GP–CP collaboration in AMS is a piecemeal process, but increased trust towards each other’s professional competency and appreciation of each other’s AMS roles might foster good collaboration,” the authors said.

“The lack of interrofessional trust on, and training to improve, professional AMS competency was consistent with the published literature.”

The authors said professional bodies should play a role in developing “clear consensus guidelines defining inter-professional activities including checklists to improve the routine AMS practice by
GPs and CPs”. 

However, though most CPs were highly supportive of their inter-professional role in AMS being defined by their professional organisations, GPs were hesitant, they found.

A review of the situation internationally found that in a few countries such as the UK, USA and the Netherlands, pharmacists were “further ahead in their engagement in promoting AMS programs  compared to Australia”.

This was perhaps due to their health system being more supportive to, and positive attitudes of GPs and CPs towards, GP–CP collaboration, the authors speculated.

“Our study emphasises that some key structural developments are required to improve GP–CP interactions about antimicrobial prescriptions and optimally manage primary care patients with infections,” they said.

“The current form of ‘MHR’ did not allow CPs to communicate with GPs regarding antimicrobial prescriptions in many cases where indications or reasons for prescribing antimicrobials were missing. This prevents CPs to comment on GPs’ antimicrobial prescribing”.

“Additionally, a lack of IT support, timely access to diagnostic and antibiogram reports, and availability to each other that hindered study CPs’ ability to query or communicate with GPs”.

Previous research had found these barriers were commonly faced by primary care prescribers when making decisions about antimicrobial(s), they said.

“The mandatory integration of clinical indications into patients’ MHRs and telehealth-led reviewing of antimicrobial prescription(s) might increase the digital interpretability of antimicrobial prescriptions and case-conferencing where necessary to assure appropriateness of antimicrobial recommendations by CPs”.

While there were opportunities for GP–CP collaboration to foster AMS implementation in Australian primary care, “significant challenges remain in how to improve interprofessional education, trust, and competencies for AMS,” the researchers concluded.

“There is a need for GPs and CPs to recognise their interprofessional roles in identifying patients who truly need antimicrobials, and improving the choice, dose, and duration of antimicrobials to reduce
avoidable AMR”.

“The arrangement of health system structure and policies that improve the GP–pharmacy collaborative practice agreements would support the development of a GP–CP collaborative antimicrobial stewardship model in Australia”.

The research was published in the journal Antibiotics.

Click here for a recent AJP clinical tips column on antimicrobial resistance and stewardship

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