Abstract Objective: This systematic review aims to synthesize evidence from current literature to describe how Electronic Medical Record (EMR) primary care data have been used for antimicrobial stewardship activities internationally. Design: Systematic literature review. Methods: We searched Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Scopus, and Web of Science from January 1, 2013 to September 23, 2023 to retrieve studies that included concepts of “antimicrobial stewardship,” “primary care,” and “electronic medical records.” We used narrative synthesis to classify and interpret results. Data were grouped and tabulated by similar themes and concepts, including strengths, facilitators, barriers, and limitations for antimicrobial stewardship. Results: A total of 265 articles were identified from the initial search, of which 34 full-text articles from 10 countries met all criteria and were included in the review. Six categories of EMR data use were identified from the studies, these were for: assessing antimicrobial prescribing quality, measuring the effectiveness of an intervention, analyzing antimicrobial prescribing trends, assessing patient and provider characteristics in prescribing, evaluating novel tools or measures, and measuring specific conditions and outcomes. Facilitators of use of EMR data were generally well-described across the studies reviewed; however, barriers were not. Barriers described were centered around EMR system design and technical challenges in data extraction. Completeness of EMR data was the most consistently described limitation. Conclusions: Our study highlights the range of uses of EMR data in supporting AMS in primary care internationally, and its strengths, facilitators, and barriers to use.

BACKGROUND:Skin and soft tissue infections (SSTIs) are among the most common indications for antimicrobial prescribing in hospitals. Inappropriate antimicrobial use can lead to increased morbidity, unnecessary hospital re-admission and increased antimicrobial resistance. This study aimed to assess the quality of antimicrobial prescribing practices in SSTI management within Australian hospitals to provide guidance for future practice. METHODS:A retrospective analysis was conducted with data from the National Antimicrobial Prescribing Survey (NAPS). SSTI prescribing data from Hospital NAPS (2013-2022) and surgical site infection data from Surgical NAPS (2016-2022) datasets were analysed. Variables assessed included guideline compliance, appropriateness as per the structured NAPS algorithm, and reasons for inappropriateness. RESULTS:From the Hospital NAPS dataset, 40,535 antimicrobial prescriptions for SSTIs were analysed. The most common indication was cellulitis (34.1%, N=13,822), and the most prescribed antimicrobial was flucloxacillin (18.8%, N=7,638). SSTI indications had a lower rate of guideline compliance but a higher rate of appropriateness compared with all other indications for antimicrobial prescriptions (guideline compliance 66.3%, N=21,035 vs 67.4%, N=156,285; appropriateness 75.6%, N=30,639 vs 72.7%, N=209,383). The most common reason for inappropriateness was incorrect dose or frequency (29.3%, N=2367). From the Surgical NAPS dataset, 5674 prescriptions for surgical site infections were analysed. Of these, 68.2% (N=3867) were deemed to be appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%, N=350). CONCLUSIONS:As SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimize antimicrobial use for SSTI management is recommended to improve patient outcomes.

BACKGROUND:Interest in using primary care data for research is growing with increasing recognition of its potential for improving healthcare. Many issues exist, some inherent in the data and others external.OBJECTIVE:This paper explores the main issues associated with the use of primary care data for research and proposed solutions to address them.DISCUSSION:Issues related to the use of primary care data for research are complex. Government reimbursement system administrative data have limitations as they lack clinical detail. General practice electronic medical record data are more suitable; however, challenges include variable data quality and interoperability. There are concerns from general practices and the public about data access and use. Strategies to address these issues include incorporating best-practice principles, implementing standards and data quality frameworks, creating partnerships between data custodians and ensuring robust governance systems exist. Leadership and the will of key stakeholders to reform, with governmental support in implementing required actions, must be prioritised.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

BACKGROUND AND OBJECTIVES:Australia has relatively high rates of antibiotic prescribing in the community. The aim of this study was to identify clinical insights regarding antibiotic prescribing choices for the management of common upper respiratory tract infections through analysis of anonymised primary care electronic medical records (EMRs).METHOD:EMR data relating to 1926 antimicrobial prescriptions for tonsillitis, pharyngitis and acute rhinosinusitis in adults and acute otitis media (AOM) in children were extracted from 11 general practices in Victoria and analysed for consistency with Australian Therapeutic Guidelines recommendations.RESULTS:The analysis suggests that underdosing of amoxicillin for AOM in children, prescription of phenoxymethylpenicillin at doses not consistent with Therapeutic Guidelines recommendations for tonsillitis and pharyngitis in adults, and potential overprescription of antibiotics for patients with acute rhinosinusitis are not infrequent in general practice.DISCUSSION:Anonymised EMR data provide an opportunity to analyse antibiotic prescribing practices at scale and provide insights relevant to clinical practice.

Inappropriate antimicrobial prescribing contributes to increasing antimicrobial resistance. An antimicrobial stewardship (AMS) program in the form of quality improvement activities that included audit and feedback, clinical decision support and education was developed to help optimise prescribing in general practice. The aim of this study was to evaluate the implementation of this program (Guidance GP) in three general practices in Melbourne, Australia, between November 2019 and August 2020. Thirty-one general practitioners (GPs) participated in the program, with 11 GPs and three practice managers participating in follow-up focus groups and interviews to explore the acceptability and feasibility of the program. Our findings showed that the quality improvement activities were acceptable to GPs, if they accurately fit GPs’ decision-making process and workflow. It was also important that they provided clinically meaningful information in the form of audit and feedback to GPs. The time needed to coordinate the program, and costs to implement the program were some of the potential barriers identified. Facilitators of success were a “whole of practice” approach with enthusiastic GPs and practice staff, and an identified practice champion. The findings of this research will inform implementation strategies for both the Guidance GP program and AMS programs more broadly in Australian general practice, which will be critical for general practice participation and engagement.

Background: Pharmacists routinely interpret and optimize tobramycin dosing for people with cystic fibrosis (PwCF). Objectives: To determine the impact of tobramycin therapeutic drug monitoring (TDM) education on pharmacist dose recommendations, and to explore nurses' and medical doctors' perceptions toward pharmacist-led TDM charting. Methods: This study involved 3 phases: a 12-month retrospective audit of PwCF prescribed tobramycin to identify the appropriateness of pharmacists' dose recommendations, a pharmacist tobramycin educational intervention utilizing a voiceover presentation with pre- and post-online tobramycin TDM assessment (involving multiple choice pharmacokinetics and case-based scenario questions), and a cross-sectional survey of respiratory nurses' and doctors' perceptions toward pharmacist-led TDM charting. The pharmacists' dose recommendations, in the audit and case-based questions, were considered appropriate if subsequent levels achieved the targeted area under the curve (AUC). Results: Audit results revealed that 44.4% of the 277 pharmacist dose recommendations identified were appropriate. The pre- and post-interventional assessments were completed by 51 and 52 pharmacists, respectively. Post intervention, correct scores were significantly higher than pre-intervention, evident in both the pharmacokinetics (median score 75% vs 100%; P = 0.048) and case-based scenario (median score 60% vs 90%; P < 0.0001) questions. Of the 54 nurses and medical doctors surveyed, 92.6% supported the implementation of pharmacist-led tobramycin charting. Conclusion: The study demonstrated an increased accuracy and appropriateness of pharmacists' tobramycin pharmacokinetics knowledge and TDM dose recommendations post-educational intervention and highlighted nurses' and medical doctors' support of pharmacist-led tobramycin TDM charting.

Journal of Pharmacy Practice and ResearchVolume 51, Issue 3 p. 247-264 PRACTICE STANDARD Standard of practice in infectious diseases for pharmacy services Kelly A. Cairns BPharm, GDipClinPharm, MClinPharm, MSHP, Corresponding Author Kelly A. Cairns BPharm, GDipClinPharm, MClinPharm, MSHP specialtypractice@shpa.org.au orcid.org/0000-0002-9969-3972 Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Pharmacy Department, Alfred Health, Melbourne, Australia Address for correspondence: Kelly A. Cairns, Infectious Diseases Leadership Committee, The Society of Hospital Pharmacists of Australia, Collingwood, Victoria, Australia. E-mail: specialtypractice@shpa.org.auSearch for more papers by this authorMinyon Avent BPharm, BSc(Hons), PharmD, BCPS, FSHP, AdvPracPharm, BCPS-AQ Infectious Diseases, Minyon Avent BPharm, BSc(Hons), PharmD, BCPS, FSHP, AdvPracPharm, BCPS-AQ Infectious Diseases Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Queensland State-Wide Antimicrobial Stewardship Program, Infection and Immunity Theme, UQCCR, The University of Queensland, Brisbane, AustraliaSearch for more papers by this authorEvette Buono BPharm, MBA(Health Management), Cert IV TAE, MPS, MSHP, Evette Buono BPharm, MBA(Health Management), Cert IV TAE, MPS, MSHP Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Clinical Excellence Commission, Sydney, Australia National Centre for Antimicrobial Stewardship, Doherty Institute, Melbourne, AustraliaSearch for more papers by this authorRon Cheah BPharm, GradCertPharmPrac, MPharmPrac, MSHP, Ron Cheah BPharm, GradCertPharmPrac, MPharmPrac, MSHP Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia National Centre for Antimicrobial Stewardship, Doherty Institute, Melbourne, Australia Pharmacy Department, Monash Health, Clayton, AustraliaSearch for more papers by this authorMisha Devchand BPharm(Hons), GradCertPharmPrac, MClinPharm, MSHP, Misha Devchand BPharm(Hons), GradCertPharmPrac, MClinPharm, MSHP Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Austin Health, Heidelberg, AustraliaSearch for more papers by this authorSharmila Khumra BPharm, MSHP, Sharmila Khumra BPharm, MSHP Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Austin Health, Heidelberg, AustraliaSearch for more papers by this authorMatthew Rawlins BPharm MBA, MSHP, Matthew Rawlins BPharm MBA, MSHP orcid.org/0000-0002-6525-1084 Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Department of Pharmacy, Fiona Stanley Hospital, Murdoch, AustraliaSearch for more papers by this authorJason A. Roberts PhD, B Pharm (Hons), B App Sc, FSHP, FISAC, Jason A. Roberts PhD, B Pharm (Hons), B App Sc, FSHP, FISAC orcid.org/0000-0001-6218-435X Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia The University of Queensland Centre for Clinical Research, Faculty of Medicine & Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia Royal Brisbane and Women’s Hospital, Brisbane, Australia Nîmes University Hospital, University of Montpellier, Montpellier, FranceSearch for more papers by this authorKristin Xenos BPharm, MPH/MHM, AdvPP (III), FSHP, Kristin Xenos BPharm, MPH/MHM, AdvPP (III), FSHP Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Australian Commission on Safety and Quality in Health Care, Sydney, AustraliaSearch for more papers by this authorCourtney Munro BPharm, GradCertPharmPrac, MPharmPrac, FSHP, AACPA, PhD, Courtney Munro BPharm, GradCertPharmPrac, MPharmPrac, FSHP, AACPA, PhD orcid.org/0000-0001-6941-7670 The Society of Hospital Pharmacists of Australia, Collingwood, AustraliaSearch for more papers by this author Kelly A. Cairns BPharm, GDipClinPharm, MClinPharm, MSHP, Corresponding Author Kelly A. Cairns BPharm, GDipClinPharm, MClinPharm, MSHP specialtypractice@shpa.org.au orcid.org/0000-0002-9969-3972 Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Pharmacy Department, Alfred Health, Melbourne, Australia Address for correspondence: Kelly A. Cairns, Infectious Diseases Leadership Committee, The Society of Hospital Pharmacists of Australia, Collingwood, Victoria, Australia. E-mail: specialtypractice@shpa.org.auSearch for more papers by this authorMinyon Avent BPharm, BSc(Hons), PharmD, BCPS, FSHP, AdvPracPharm, BCPS-AQ Infectious Diseases, Minyon Avent BPharm, BSc(Hons), PharmD, BCPS, FSHP, AdvPracPharm, BCPS-AQ Infectious Diseases Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Queensland State-Wide Antimicrobial Stewardship Program, Infection and Immunity Theme, UQCCR, The University of Queensland, Brisbane, AustraliaSearch for more papers by this authorEvette Buono BPharm, MBA(Health Management), Cert IV TAE, MPS, MSHP, Evette Buono BPharm, MBA(Health Management), Cert IV TAE, MPS, MSHP Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Clinical Excellence Commission, Sydney, Australia National Centre for Antimicrobial Stewardship, Doherty Institute, Melbourne, AustraliaSearch for more papers by this authorRon Cheah BPharm, GradCertPharmPrac, MPharmPrac, MSHP, Ron Cheah BPharm, GradCertPharmPrac, MPharmPrac, MSHP Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia National Centre for Antimicrobial Stewardship, Doherty Institute, Melbourne, Australia Pharmacy Department, Monash Health, Clayton, AustraliaSearch for more papers by this authorMisha Devchand BPharm(Hons), GradCertPharmPrac, MClinPharm, MSHP, Misha Devchand BPharm(Hons), GradCertPharmPrac, MClinPharm, MSHP Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Austin Health, Heidelberg, AustraliaSearch for more papers by this authorSharmila Khumra BPharm, MSHP, Sharmila Khumra BPharm, MSHP Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Austin Health, Heidelberg, AustraliaSearch for more papers by this authorMatthew Rawlins BPharm MBA, MSHP, Matthew Rawlins BPharm MBA, MSHP orcid.org/0000-0002-6525-1084 Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Department of Pharmacy, Fiona Stanley Hospital, Murdoch, AustraliaSearch for more papers by this authorJason A. Roberts PhD, B Pharm (Hons), B App Sc, FSHP, FISAC, Jason A. Roberts PhD, B Pharm (Hons), B App Sc, FSHP, FISAC orcid.org/0000-0001-6218-435X Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia The University of Queensland Centre for Clinical Research, Faculty of Medicine & Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia Royal Brisbane and Women’s Hospital, Brisbane, Australia Nîmes University Hospital, University of Montpellier, Montpellier, FranceSearch for more papers by this authorKristin Xenos BPharm, MPH/MHM, AdvPP (III), FSHP, Kristin Xenos BPharm, MPH/MHM, AdvPP (III), FSHP Infectious Diseases Standard of Practice Working Group, The Society of Hospital Pharmacists of Australia, Collingwood, Australia Australian Commission on Safety and Quality in Health Care, Sydney, AustraliaSearch for more papers by this authorCourtney Munro BPharm, GradCertPharmPrac, MPharmPrac, FSHP, AACPA, PhD, Courtney Munro BPharm, GradCertPharmPrac, MPharmPrac, FSHP, AACPA, PhD orcid.org/0000-0001-6941-7670 The Society of Hospital Pharmacists of Australia, Collingwood, AustraliaSearch for more papers by this author First published: 27 June 2021 https://doi.org/10.1002/jppr.1744Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. 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BACKGROUND:Australian residential aged care facilities (RACFs) are encouraged to participate in an annual Aged Care National Antimicrobial Prescribing Survey. This data source was analysed to describe patterns of topical antimicrobial prescribing and thereby provide insight into antimicrobial stewardship (AMS) changes that might be required.METHODS:2018 and 2019 survey data was analysed.RESULTS:The overall prevalence of the 52,431 audited residents (629 facilities) who were prescribed 1 or more topical antimicrobials was 2.9%. Of all prescribed antimicrobials (n=4899), 33.0% were for topical application. Most frequently prescribed topical antifungals were clotrimazole (85.3%) and miconazole (9.1%), and antibacterials chloramphenicol (64.1%) and mupirocin (21.8%). Tinea (38.3%) and conjunctivitis (23.8%) were the 2 most common indications. Topical antimicrobials were sometimes prescribed for pro re nata administration (38.8%) and greater than 6 months (11.3%). The review or stop date was not always documented (38.7%).CONCLUSIONS:To reduce the possibility of adverse consequences associated with antimicrobial use, antimicrobial stewardship programs in Australian residential aged care facilities should at least ensure mupirocin is appropriately used, first line antimicrobial therapy is prescribed for tinea, chloramphenicol is prescribed for conjunctivitis only if necessary, pro re nata orders for prescriptions are discouraged and to avoid prolonged duration of prescriptions, review or stop dates are always documented.

The pharmacist’s role in hospital antimicrobial stewardship (AMS) programs is known to improve patient safety and the quality of care. Despite this, many Australian hospitals struggle to provide adequate pharmacy AMS program resourcing and need to explore newer models of care. The Pharmacy Board of Australia’s Guidelines for Dispensing Medicines permit suitably qualified, competent and experienced pharmacy technicians to assist pharmacists in ‘tasks in a pharmacy department’. The pharmacy technician workforce is expanding, and there is growing interest in career advancement and expansion of the pharmacy technician role. We propose that the pharmacy technician, a well-integrated member of many Australian hospital pharmacy departments, can play an important role in hospital AMS programs. To bolster AMS initiatives in Australian hospitals, this paper explores the existing evidence for pharmacy technicians in AMS programs and describes how this role may be better supported in Australia.

Background: Australia has ~2,700 aged-care homes and 180 multipurpose services. The annual Aged Care National Antimicrobial Prescribing Survey (AC NAPS), first pilot tested in 2015, is a surveillance tool that can be used in these facilities to monitor infections and antimicrobial use. It assists in identifying priorities for local and national infection control and antimicrobial stewardship interventions. Methods: Nurses or pharmacists collect point prevalence data using standardized data collection forms: (1) A facility form, completed by each participating facility, includes resident-level data fields (eg, number of residents present on the survey day). (2) An infection form is completed for residents with signs and/or symptoms of infection. (3) An antimicrobial form is completed for residents who are prescribed an antimicrobial. Results: Regarding prevalence,for those 31 facilities that participated annually, there was no significant change in either prevalence rate (Table 1). Regarding priority areas for improvement (2018 data only), 64.6% of prescriptions were for residents who did not have signs and/or symptoms of a suspected infection in the week prior to the antimicrobial start date. The most common clinical indications for prescriptions were skin soft-tissue and mucosal infection (18.3%), cystitis (16.0%) and pneumonia (9.4%). Cefalexin (20.3%), clotrimazole (19.0%), and chloramphenicol (7.0%) were the most commonly prescribed antimicrobials. Review or stop dates were not documented for 58.9% of prescriptions. Only 39.2% of antimicrobials were prescribed in the 7 days prior to the survey day; 28.3% were prescribed >6 months prior. Furthermore, 36.3% of all prescriptions were for topical application. In addition, 19.0% of antimicrobials were prescribed for PRN (as needed) administration; most (94.4%) of these were for topical antimicrobials, most commonly clotrimazole (65.4%). Conclusions: The AC NAPS has identified infections and consistent patterns of antimicrobial use that may adversely affect the safety of care for Australian aged-care residents. Interventions are now being developed, implemented, and evaluated to address identified ‘priority areas for improvement.’Funding: NoneDisclosures: None