{
  "abstract": "Introduction Antimicrobial resistance is an escalating global concern. Although there has recently been a decline in antimicrobial dispensing within Australian communities, prescription rates remain higher than in comparable healthcare systems. This is primarily due to inappropriate prescribing arising from overdiagnosing bacterial causes of acute respiratory tract infections (ARIs). Community-based antimicrobial stewardship initiatives have been proposed to enhance appropriate antibiotic use. This study employed an Experience-Based Co-design approach to explore the barriers and facilitators influencing quality antibiotic use for adult ARIs in primary care from the perspectives of healthcare professionals and patients. Additionally, the study aimed to gather insights into preferred resources and workflow adjustments that could support the quality use of antibiotics and antimicrobial stewardship practices.Methods Patients and healthcare professionals participated in three focus group discussions (FGs) designed to elicit their experiences with ARI symptoms and management in primary care, facilitate comparisons of their perspectives, and obtain feedback on proposed and revised resources. Transcripts from the discussions were analysed thematically using the Theoretical Domains Framework to identify barriers and enablers of practice change aligned with the Capability, Opportunity, Motivation-Behaviour (COM-B) model.Results The study recruited ten healthcare professionals, comprising six general practitioners, two pharmacists, one microbiologist, and one general practice receptionist, from rural, regional, and metropolitan locations across two Australian states (New South Wales and Tasmania). Additionally, ten patients aged between 28 and 84 years participated. Thematic analysis identified key factors at the patient level (acceptance and engagement, therapeutic alliance, personalised planning, and harm minimisation), provider level (clinical expertise, interprofessional collaboration, peer norms, and professional culture), and system level (delayed prescribing, resource accessibility, practice-wide initiatives, and continuity of care). Redesigned resources were recognised as potential facilitators capable of addressing identified barriers to rational prescribing. Recommendations emphasised the importance of system-level changes to overcome barriers at both patient and provider levels. These include personalised management plans, alternative therapeutic strategies, and improved expectation management regarding antibiotic use. Specific recommendations involved embedding software-based communication tools to enhance interaction between patients and health care professionals.Discussion Overdiagnosis of bacterial ARI was shown to have multi-factorial drivers at multiple levels across patients, providers and systems. To enhance antimicrobial stewardship and ensure quality use of antibiotics, it is essential to develop effective communication strategies that convey the risks of unnecessary antibiotic use and manage patient expectations. The co-designed resources developed in this study are applicable across primary care settings and may offer particular advantages in areas with limited access to a patient‘s preferred general practitioner. Integrating these co-designed resources into consultations could aid in appropriate clinical decision-making and help mitigate inappropriate prescribing of antibiotics for upper respiratory tract infections. Strengthening the therapeutic alliance through personalised management plans and educational interventions supports patient adherence to non-antibiotic treatments. Furthermore, implementing system-level changes such as delayed prescribing and practice-wide initiatives can drive sustained improvements in prescription practices, ultimately reducing antimicrobial resistance. This comprehensive approach ensures that the benefits of these resources extend effectively throughout primary care settings, especially in regional and rural areas.",
  "authors": [
    {
      "affiliations": [
        "University of Wollongong, Wollongong, Australia"
      ],
      "name": "Judy Mullan"
    },
    {
      "affiliations": [
        "University of Wollongong, Wollongong, Australia"
      ],
      "name": "Andrew Bonney"
    },
    {
      "affiliations": [
        "University of Wollongong, Wollongong, Australia"
      ],
      "name": "Colin Cortie"
    },
    {
      "affiliations": [
        "University of Wollongong, Wollongong, Australia"
      ],
      "name": "Margaret Jordan"
    },
    {
      "affiliations": [
        "University of Tasmania, Hobart, Australia"
      ],
      "name": "Jan Radford"
    },
    {
      "affiliations": [
        "University of Wollongong, Wollongong, Australia"
      ],
      "name": "Mary Burns"
    },
    {
      "affiliations": [
        "University of Wollongong, Wollongong, Australia"
      ],
      "name": "Christine Metusela"
    }
  ],
  "title": "079 Co-designed resources to help optimise antibiotic use in primary care",
  "uid": "6cbf7776-d592-5484-ba44-877651f3ef92"
}