The Optimal Implementation of Antimicrobial Stewardship In General Practice Study (OptimasGP) - Pilot study

Intervention GPs will use the online AMS Toolbox to support them to provide standard of care when consulting adult patients with acute respiratory infections who would normally seek treatment from their GP. Patients with acute respiratory tract infections will attend their GP as they normally would e.g. booking in, paying the normal amount for a consultation if required. Examples of the resources included in the AMS Toolbox include the CDC Delayed Prescribing tool, the Australian Commission on Safety and Quality in Healthcare's Decision Aid for acute bronchitis, the National Institute for Health and Care Excellence's Cough (Acute): Antimicrobial Prescribing tool, and a treatment plan developed by University of Wollongong researchers through co-design. During consultations, GPs will use the AMS Toolbox to record having seen an adult patient with a respiratory infection (no patient details are collected) and whether or not they prescribed an antibiotic. If the GP considers it clinically appropriate, they can choose one of the AMS Toolbox resources to support their standard clinical care. The AMS Toolbox will include resources for shared decision making, clinical decision-making support with the addition of point-of-care testing if appropriate, and delayed prescription. These resources will be available online and in hard copy. GPs are able to share these resources with patients if desired. GPs will decide which resource to use, if any, during the consultation. Use of the AMS Toolbox is expected to take 5-10 minutes per consultation depending on which AMS resources are used. The decision to prescribe an antibiotic or not is completely up to the GP and patient. Patients may be offered a point-of-care testing to inform clinical decision making. The decision to conduct a point-of-care test will be made by the GP and the patient together using a clinical decision making guide. This test will require a finger prick test – this is entirely voluntary and is a standard method used to obtain blood for routine tests in general practice such as blood glucose tests. Approximately 3 drops of blood will be removed by finger stick. Blood will be tested using a point of care testing device using standard procedures. Results from this test are not recorded as part of the trial, and are only used as part of the clinical decision making process. There will be no additional charge to the patient for the test. Point-of-care testing will be for C-reactive protein (CRP). A CRP level of <20mg/l indicates that bacterial infection is unlikely and provides support for not prescribing an antibiotic. A CRP level of 20-100mg/l suggests a bacterial infection may be possible and an antibiotic could be prescribed in consideration with other factors, while a CRP rating above 100mg/l suggests the infection is bacterial and an antibiotic should be prescribed. Two point-of-care testing devices will be piloted: an Affinion 2 analyser and a Quikread Go. Both devices are approved by the Australian Therapeutic Goods Agency and are currently available to GPs who wish to buy them. Each device will be used by one of the six practices for a month after which time it will be moved on to the next practice i.e. each of the six practices will use a POCT device for a month. Training on the use of the devices will be included as part of the GP pre-trial training. Adherence will be monitored using 1) qualitative interviews at the end of the study, 2) a comparison of the rates of data entry into the AMS Toolbox vs an audit of practice data. The implementation support offered to GPs - Change in workflow: the AMS Toolbox will centralise intervention resources to make them more accessible - Reminder: A small post-card sized card will be given to each GP to remind them to complete their data analysis. - Training: Two hours of online videos will be provided by members of the research team. This will recorded videos and are expected to be viewed in 1-2 sessions.