Workflow-based data solutions are required to support antimicrobial stewardship in general practice

Overuse of antibiotics contributes to the growing problem of antibiotic resistance in pathogens, which is impacting not only on health systems but the global economy. To manage the problem, we must ensure adequate treatment and prevention of infection, while looking for opportunities to minimise the harm from unnecessary use of antibiotics. To optimise antibiotic prescribing, we must know which antibiotics are being prescribed, to whom they are prescribed and the clinical indications for those prescriptions. These data can then be analysed for opportunities to effect and monitor change in antimicrobial stewardship (AMS) programmes. Most of the antibiotics consumed by humans are prescribed in the community, so the general practice setting is important for AMS. Community antibiotic data often come from dispensed prescriptions (sales), but dispensed prescriptions may include prescriptions from other community settings and providers (eg, residential facilities, hospital outpatients) or may not include all general practice prescriptions (eg, private prescriptions). This obscures the specific contribution by general practitioners in general practice. The reasons for prescriptions are not available in most dispensed prescriptions. Surveys are also used, which collect the reason(s) for prescription, but these are resource intensive. A range of commercially available clinical software is used in general practice but they have limited interoperability, so the secondary analysis of electronic medical records (EMRs) and the targeting and monitoring of AMS initiatives has been difficult. The aim of this study is to investigate the extent to which prescribing data available from Australian general practice EMRs can be used to identify possible targets for AMS by comparing antibiotic prescribing with antibiotic prescribing guidelines.