Author: Charles Gilks, Chief Investigator and Head of the UQ School of Public Health.

The General Practitioners Antimicrobial Stewardship Programme Study (GAPS) aims to decrease antibiotic resistance in Australia by reducing antibiotic prescribing rates for acute respiratory infections.

Led by UQ’s School of Public Health and partnered with Bond University and QUT, the GAPS Project was contracted by the Department of Health in 2015 to develop the evidence-base for Antimicrobial Stewardship (AMS) in general practice settings.

With Australia one of the highest consumers of antibiotics in the Industrialised world – around 45 per cent of Australians receive at least one antibiotic prescription a year – the GAPS project is crucial to combatting over-prescription.

There is a strong link between antibiotic consumption and rates of antimicrobial resistance; and resistance is an emerging threat globally. 

AMS is the coordinated set of actions designed to promote and increase the appropriate use of antimicrobials and is a key strategy to conserve the effectiveness of antibiotics.

Australia’s first national antimicrobial resistance strategy for 2015-2019 states that there is a need to implement AMS in all settings including primary care and general practice.  

To date AMS has largely been a hospital-based activity led by infection control teams and with hospital pharmacists as gatekeepers.

A set of interventions identified by GAPS that had each been shown to work in controlled trial settings were put together as an integrated package.

The study involved 29 GP practices in South East Queensland that were randomly allocated to be either an intervention practice, to receive training and support to roll the package out; or to be a control practice.

The GAPS study ran for six months over the summer period and involved a total of 110 General Practitioners who were assessed on their attitudes to the package and its implementation.

The GPs valued the package’s flexibility and the fact that it could be tailored to the individual patient and GP skill set. As a consequence, it was well liked and used.

Prescribing data was collected from each GP, for the baseline three years prior to the intervention, then for the study period. Overall, nearly three million prescriptions were extracted from PBS records.

The project results indicate a measurable decline in antibiotic prescribing between the baseline and study periods as several campaigns were run to promote more appropriate use of antibiotics. In the study period itself, intervention practices showed a significant seven per cent overall reduction in antibiotic prescribing which equated to almost four fewer antibiotic prescriptions per GP per month with use of the integrated AMS package.

This was achieved in the summer period when antibiotic prescribing dips markedly.

The final part of the study was an economic analysis.

From the perspective of the health system, the cost was $121 per prescription avoided. If the benefits of adverse events like skin rashes and diarrhoea were included, the cost fell to $73 per antibiotic avoided.

It is likely that economies of scale will come into play in a real-world roll out.

Using conservative assumptions, a roll out of the integrated package to 250 GP practices over three years would likely be cost-saving, with the costs of implementation offset by over $200,000 of healthcare costs saved.

UQ researchers involved in the project:
Charles Gilks: Chief Investigator and Head of the UQ School of Public Health.
Minyon Avent: Project Manager and Consultant Clinical Pharmacist, UQ.
Annette Dobson: Professor of Biostatistics, UQ School of Public Health.
Mahmoud Galal: Research Assistant, UQ School of Public Health.
Mieke van Driel: Head of Discipline of General Practice, UQ School of Medicine.
Laura Deckx: Postdoctoral Research Fellow at the Discipline of General Practice, UQ School of Medicine.
Chi-Wai Lui: Lecturer, Division of Health Systems, Policy and Services, UQ School of Public Health.
David Paterson: Consultant Infectious Diseases Physician and Consultant Microbiologist
Hanna Sidjabat: Research Officer, UQCCR.