Ruby Biezen

Background and objectives: Antimicrobial stewardship initiatives are designed to improve the appropriateness of antimicrobial use and thereby maximize benefits and minimize risks. Currently, there is no shared understanding of appropriate use. Qualitative research with key stakeholders in human and animal health is critical to inform a One Health definition and to support global stewardship efforts. Methods: Four qualitative focus groups were held in 2024 with livestock producers, consumers, healthcare professionals and policymakers to examine factors affecting antimicrobial use and stewardship. A thematic analysis methodology informed by grounded theory was adopted, capturing themes as they emerged directly from the data. Results: Thematic analysis identified two themes:Structural and economic barriers; in animal health, consumer demand for free-range or antibiotic-free produce conflicted with practical antimicrobial use. This was compounded by differences between large and small livestock enterprises and regulatory constraints around off-label antimicrobial use. In human health, time pressure, limited access to review appointments and conflicting consumer–prescriber expectations influenced antimicrobial decision-making.Information access and education; participants identified gaps in antimicrobial stewardship education for livestock producers, limited public understanding of appropriate use and underused communication channels to support consistent context-specific messaging. Conclusion: This study highlights how participants understood appropriate antimicrobial use across One Health sectors and the structural, economic, informational and educational factors they perceived as shaping whether it could be achieved in practice. Establishing contextualized, consensus definitions is essential for measuring prescribing quality, benchmarking practice and targeting stewardship interventions. These findings will inform an international Delphi process to develop practical, implementable One Health definitions of appropriate use.

Background/Objectives: Antimicrobials are regularly prescribed in general practice, yet the infrastructure to support routine review of prescribing in this setting remains limited. Integrated antimicrobial stewardship (AMS) interventions combining automated auditing of routine prescribing data with an educational component are a promising approach to addressing this gap. This qualitative study aimed to explore general practitioner (GP) and practice manager (PM) perspectives on the acceptability, feasibility, and perceived effectiveness of such an intervention implemented across 31 general practices and 97 GPs in Victoria, Australia. It also explored implementation considerations relevant to future scaling of the intervention. This is one of the first studies of GP and PM perspectives on this type of integrated program. Methods: Semi-structured interviews were conducted with 17 GPs and 5 PMs and analyzed using both inductive and deductive thematic analysis. The Theoretical Domains Framework (TDF) informed interview guide development and deductive coding; themes were generated inductively and final themes mapped to the Capability, Opportunity, Motivation–Behavior (COM-B) model for presentation. Results: Four themes were identified: (1) trust, validity, and value of audit and feedback; (2) clinical judgement and patient factors in prescribing complexity; (3) social, organizational, and professional contexts of learning and behavior change; and (4) effort, usability, and workflow in engagement with the intervention. Conclusions: Participants valued AMS activities that supported reflective practice without undermining professional autonomy. Trust in the systems managing prescribing data was a precondition for engagement with the data itself. Engagement also depended on fit with existing workflows, individualized reporting, and contextualized feedback. The social conditions under which learning occurred, such as peer interaction, moderated discussion, and collaborative reflection, mattered as much as the technical components of a program.

UNSTRUCTURED The rise of online research methods for recruitment and data collection following the COVID-19 pandemic has coincided with a growing threat to research integrity: imposter participants who falsify experiences to participate in paid studies. This viewpoint article provides a summary of the contemporary evidence on combatting imposter participants and proposes universal, evidence-based guidelines. Case reports and scoping reviews examining this threat are numerous, and some recommend guidelines for various study designs. Few studies have examined prevalence, financial implications and personal impacts. Imposter participants pose a persistent, evolving threat to online research. Responsibility cannot rest with individual researchers alone. Guidelines along with investment in institutional supports are urgently needed to safeguard data integrity and maintain public trust in research. Our recommended guidelines target each part of the research eco-system: 1) publishers, editors and checklist authors; 2) national funding and ethics bodies; 3) universities and other research institutions; and 4) researchers and study teams.

Background/Objectives: Inappropriate use of antibiotics contributes to the rise in antibiotic-resistant bacteria and can result in adverse drug effects for individuals. Informed discussions between patients and general practitioners (GPs) can help ensure that treatment decisions about antibiotic use align with the best health outcomes for individuals. Methods: We implemented a set of information resources designed to support clinical discussions and decision-making for patients with common infections in primary care. A suite of patient information sheets, which had been co-designed with primary care providers and consumers, were implemented in eight general practices in metropolitan Melbourne and regional Victoria, from August to November 2020. Results: Post-implementation evaluation, conducted through interviews with 15 primary care providers and 13 patients, revealed that the information sheets were simple, easy to use and generated discussion within consultations. GPs reported using the sheets to reinforce their decision-making during consultations with patients, reduce potential conflict, provide alternatives to antibiotic prescriptions, and offer patients a written summary of management recommendations. Patients found the sheets informative and that they made it easier to understand their diagnosis and to manage their conditions. Both GPs and patients agreed that the content was relevant and effectively enhanced patients’ knowledge of disease conditions, treatment options, and when to seek medical advice and were facilitators of meaningful conversations during consultations. Conclusion: These resources are acceptable in Australian primary care and publicly available for use by GPs, pharmacists and patients in Australia.

Background: Patients presenting with dental pain are common in general practice, despite dental infections being most appropriately managed with dental treatment to address the cause of the infection. Although antibiotics are not appropriate for the management of localised toothache without signs of systemic spread, general practitioners (GPs) often prescribe antibiotics and analgesics for the management of dental pain. The aim of this study was to explore GPs’ perceptions and management of dental presentations in Australia. Methods: Twelve semi-structured interviews were conducted with GPs across Victoria, Australia, between October 2022 and January 2023. Data were thematically analysed. Results: The study found that dental pain was the most common presenting complaint for patients attending general practice with a dental problem. Five major themes were identified in this study: knowledge, beliefs about capabilities, emotion, environmental context and resources, and social influences/social professional role and identity. In terms of knowledge and capabilities, GPs would advise patients to seek dental care, as they are aware that antibiotics would not resolve the underlying issue. Challenges for GPs included limited training in oral and dental treatment, as well as emotions, such as patient anxiety and phobia resulting in patients seeking dental care through a GP rather than a dentist. Barriers due to the context, such as access to dental care, long waiting lists within the public dental system and cost, were some of the reasons patients present to general practice rather than a seeing a dentist. Furthermore, issues that influenced GPs’ antibiotic prescribing included patients’ expectations for antibiotics to treat their dental pain, as well as dentists advising their patients to attend their GP for antibiotics prior to dental treatment. Conclusions: This study identified factors that influenced GPs’ management of patients with dental conditions. To address these issues, it is imperative to develop interventions addressing patients’ knowledge around oral health, as well as providing improved access to dental care for these patients.

Antibiotic resistance is a threat to global health, and inappropriate antibiotic use can be associated with adverse effects. Developing tools to encourage better communication between patients and general practitioners may reduce inappropriate use of antibiotics. The aim of the study was to develop shared decision support tools on common infections using a co-design methodology to address antimicrobial stewardship (AMS) in primary care. Three co-design/interview sessions were conducted with primary care providers and consumers between October 2019–April 2020 in Melbourne, Australia. Participants critiqued existing AMS tools, identified key elements required and optimised resulting prototypes. Primary care providers and consumers prioritised information to include in the AMS tools, such as when to see a doctor, management options, disease symptoms and cause of infection differently. However, both agreed content should be communicated in a plain, concise and logical manner, using inclusive and simple language accompanied by illustrations. Information sheets should be single-sided and A4-sized, appropriate for use before, during or after consultations. Co-design provided a collaborative forum to systematically design and develop products that meet the needs of both primary care providers and consumers. This resulted in the development of seven patient information sheets on common infections that encourage discussion of these infections, conservative management options and appropriate antibiotic use in primary care.

Australia’s COVID-19 vaccine rollout included prioritizing older adults and those with underlying conditions. However, little was known around the factors impacting their decision to accept the vaccine. This study aimed to assess vaccine intentions, information needs, and preferences of people prioritized to receive the COVID-19 vaccine at the start of the Australian vaccine rollout. A cross-sectional online survey of people aged ≥70 years or 18–69 with chronic or underlying conditions was conducted between 12 February and 26 March 2021 in Victoria, Australia. The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework and items informed the survey design and framing of results. Bivariate logistic regression was used to investigate the association between intention to accept a COVID-19 vaccine and demographic characteristics. In total, 1828 eligible people completed the survey. Intention to vaccinate was highest among those ≥70 years (89.6%, n = 824/920) versus those aged 18–69 years (83.8%, n = 761/908), with 91% (n = 1641/1803) of respondents agreeing that getting a COVID-19 vaccine was important to their health. Reported vaccine safety (aOR 1.4, 95% CI 1.1 to 1.8) and efficacy (aOR 1.9, 95% CI 1.5 to 2.3) were associated with intention to accept a COVID-19 vaccine. Concerns around serious illness, long-term effects, and insufficient vaccine testing were factors for not accepting a COVID-19 vaccine. Preferred communication methods included discussion with healthcare providers, with primary care providers identified as the most trusted information source. This study identified factors influencing the prioritized public’s COVID-19 vaccine decision-making, including information preferences. These details can support future vaccination rollouts.

Healthcare workers’ COVID-19 vaccination coverage is important for staff and patient safety, workforce capacity and patient uptake. We aimed to identify COVID-19 vaccine intentions, factors associated with uptake and information needs for healthcare workers in Victoria, Australia. We administered a cross-sectional online survey to healthcare workers in hospitals, primary care and aged or disability care settings (12 February–26 March 2021). The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework informed survey design and framing of results. Binary regression results adjusted for demographics provide risk differences between those intending and not intending to accept a COVID-19 vaccine. In total, 3074 healthcare workers completed the survey. Primary care healthcare workers reported the highest intention to accept a COVID-19 vaccine (84%, 755/898), followed by hospital-based (77%, 1396/1811) and aged care workers (67%, 243/365). A higher proportion of aged care workers were concerned about passing COVID-19 to their patients compared to those working in primary care or hospitals. Only 25% felt they had sufficient information across five vaccine topics, but those with sufficient information had higher vaccine intentions. Approximately half thought vaccines should be mandated. Despite current high vaccine rates, our results remain relevant for booster programs and future vaccination rollouts.

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.

Objective To codesign an electronic chronic disease quality improvement tool for use in general practice. Design Service design employing codesign strategies. Setting General practice. Participants Seventeen staff (general practitioners, nurses and practice managers) from general practice in metropolitan Melbourne and regional Victoria and five patients from metropolitan Melbourne. Interventions Codesign sessions with general practice staff, using a service design approach, were conducted to explore key design criteria and functionality of the audit and feedback and clinical decision support tools. Think aloud interviews were conducted in which participants articulated their thoughts of the resulting Future Health Today (FHT) prototype as they used it. One codesign session was held with patients. Using inductive and deductive coding, content and thematic analyses explored the development of a new technological platform and factors influencing implementation of the platform. Results Participants identified that the prototype needed to work within their existing workflow to facilitate automated patient recall and track patients with or at-risk of specific conditions. It needed to be simple, provide visual snapshots of information and easy access to relevant guidelines and facilitate quality improvement activities. Successful implementation may be supported by: accuracy of the algorithms in FHT and data held in the practice; the platform supporting planned and spontaneous interactions with patients; the ability to hide tools; links to Medicare Benefits Schedule; and prefilled management plans. Participating patients supported the use of the platform in general practice. They suggested that use of the platform demonstrates a high level of patient care and could increase patient confidence in health practitioners. Conclusion Study participants worked together to design a platform that is clear, simple, accurate and useful and that sits within any given general practice setting. The resulting FHT platform is currently being piloted in general practices and will continue to be refined based on user feedback.